AVMA Collections: Disaster preparedness and response summary

 


Single-topic compilations of the information shaping our profession

 June 2008

 

The catastrophic events of the 2005 hurricane season also created a deluge of painful lessons in disaster preparedness and response. Residents of the Gulf Coast region of the United States were overwhelmed as hurricanes Katrina, Rita, and Wilma struck in succession, while disaster response systems that were assumed to be adequate proved to be far less.

Response efforts directed at helping animals achieved real success, but they also were confounded by many factors. Some of these were common to general rescue efforts surrounding these disasters, while others were specific to animal management and handling.

Beyond natural disasters such as the Gulf Coast hurricanes, the terrorist attacks on the World Trade Center and Pentagon on September 11, 2001, dramatically increased national concern regarding biosecurity and bioterrorism, including bioterrorism directed at food animals and the food supply chain. The importance of veterinarians in public health has since become much more widely understood, and a shortage of veterinarians in public health roles has become more evident.

These events have fueled intense focus and activity around improving local, state, and national preparedness and response planning for biosecurity and the handling of animals in disasters. This collection of articles reflects the arduous work of experts who have grappled with the central questions and offered their findings and recommendations within the covers of the AVMA scientific journals.

In the first section, "Disaster response," a number of response and recovery efforts for animals are examined, with investigators presenting what went right, what went wrong, and lessons learned. 

  • Following Hurricane Katrina, responders reported many inconsistencies in the decontamination procedures used by various animal intake centers. In "A method for decontamination of animals involved in floodwater disasters" the authors describe an animal decontamination protocol that aligns with current principles of the National Response Plan and can be used following water-related disasters such as floods, hurricanes, and tsunamis that expose animals to superficial contaminants.
  • In "Equine rescue and response activities in Louisiana in the aftermath of Hurricanes Katrina and Rita," the authors discuss special challenges faced by equine responders at the state level. Approximately 500 volunteers dedicated time to these efforts, with many donating their trucks, fuel, and trailers as well. During the 6 weeks of Katrina Equine Response Shelter operation, equine medical problems encountered included colic, diarrhea, dehydration, laminitis, sole abscesses, mild skin lacerations, and abrasions. Difficult and often dangerous situations were created by unauthorized rescuers, illustrating the need for training and credentialing of all personnel, including volunteers, involved in rescue and response activities. Wherever possible, animal response activities need to be coordinated at all levels through the use of the National Incident Management System's Incident Command System.
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  • In "Epidemiologic features of pet evacuation failure in a rapid-onset disaster" the authors examine factors involved in failure to evacuate pets when owners have only a few hours' notice to evacuate. In this cross-sectional study, the behavior of pet-owning households toward their pets during an evacuation necessitated by a hazardous chemical spill is described. Risk factors for pet evacuation failure were determined by comparing the characteristics of pet-owning households that evacuated with their pets with those that left their pets behind.
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    Of the 241 households studied, approximately 50% evacuated with their pets, approximately 40% evacuated without them but later attempted to rescue them, and 10% neither evacuated their pets nor attempted to rescue them. Pet evacuation failure was most common in households that thought the evacuated area was safe for pets. Risk of pet evacuation failure increased in households with many animals, low pet attachment, and low levels of preparedness. Cat evacuation failure was associated with not having cat carriers. 

  • Residents in Yuba County, California were issued a voluntary evacuation notice on the morning of January 1, 1997, because of flooding. The next day a levee broke and a mandatory evacuation was ordered. In "Risk factors for pet evacuation failure after a slow-onset disaster" the authors compared the characteristics of pet-owning households that evacuated from the flood without their pets with those that evacuated with their pets, in order to identify risk factors for pet evacuation failure.
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    Fifty percent of households evacuated with their pets, 50% without. Low pet attachment, measured in part by asking owners whether pets had visited a veterinarian in the year prior to evacuation, was significantly associated with a greater chance of pet evacuation failure. Risk of failure was also associated with pet management practices prior to the disaster, such as dogs being kept outdoors most of the time or owners not having cat carriers for their cats. Mitigation of pet evacuation failure should focus on reinforcing responsible pet ownership and strengthening the human-animal bond. 

  • The preceding studies provided evidence that a lack of previous veterinary care was linked to pet abandonment during disasters. In the article "Seroprevalence of Dirofilaria immitis, feline leukemia virus, and feline immunodeficiency virus infection among dogs and cats exported from the 2005 Gulf Coast hurricane disaster area" the authors postulated that, if failure to evacuate pets during the 2005 Gulf Coast hurricane disaster was similarly associated with a lower rate of previous veterinary care, then it is possible that rescued animals were at increased risk for diseases routinely controlled by chemoprophylaxis, neutering, vaccination, and testing.
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    The authors found that dogs and cats exported from the 2005 Gulf Coast hurricane disaster area had disease rates similar to those for animals in the region prior to the hurricanes. A concern noted was the increased risk of D immitis transmission to native dogs in low-prevalence areas after translocation of infected dogs into those areas from high-prevalence regions such as the Gulf Coast. 

  • In "Disaster relief management of companion animals affected by the floods of Hurricane Floyd" the authors describe disaster relief management performed by the North Carolina State University College of Veterinary Medicine for over 450 animals affected by Hurricane Floyd. With the help of over 750 volunteers, the field hospital was operational within 72 hours. Rapid sourcing of supplies and personnel was found to be key; much of the medical supplies, food, and transportation were donated.
  • The section titled "The veterinarian's role in preparedness and response" contains commentaries and analyses regarding the many ways veterinarians can contribute by bringing their professional expertise to bear during times of local, state, or national emergency. 

  • In "The veterinary profession's duty of care in response to disasters and food animal emergencies" the authors point out that, after numerous national disasters and disease threats in recent years, the question of large and small animal practitioner involvement in emergency response still hangs over the profession. The Incident Command System has become the national standard, and the authors explore ways in which the veterinary profession can fulfill the needs of the Incident Command System, concluding that a national policy for veterinary involvement in disasters would be beneficial.
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  • The authors of "Psychologic first aid and veterinarians in rural communities undergoing livestock depopulation" explore the novel role of veterinarians in care of the rural population. The 2001 foot-and-mouth disease outbreak in the United Kingdom allowed some US veterinarians to experience a national disease eradication event, and to observe some of the effects of depopulation on farm families and rural communities, including the potential for posttraumatic stress disorder. Psychologic first aid skills could be learned by rural veterinarians and would enable them to help their communities in the event of a livestock depopulation.
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  • Accredited veterinarians fill important roles in national biosecurity and preparedness by representing the federal government in regulatory activities such as animal inspection, control of animal movement, and foreign animal disease surveillance. In "Veterinary accreditation and some new imperatives for national preparedness" the authors explain the skills, knowledge, and aptitudes expected of accredited veterinarians and the additional areas of knowledge likely to be expected in the future. Because Homeland Security Presidential Directive-5 dictates the use of the National Incident Management System, the foundation of which is the Incident Command System, veterinarians involved in disaster response plans should understand the basic elements of the Incident Command System.
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  • In "Public health roles for small animal practitioners" the authors discuss the growing shortage of veterinarians in public health and point out the untapped potential of small animal practitioners for addressing this shortage. Because small animals may serve as sentinels for human disease, surveillance of zoonotic disease is one important role for practitioners. Additionally, the responsibilities of accredited veterinarians could be expanded to allow small animal practitioners to provide a surge capacity of regulatory veterinarians in times of animal health emergencies.
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    The unique qualifications of equine practitioners to diagnose and treat injuries and stresses affecting horses during disasters are explored in "The role of the equine practitioner in disasters." The authors found that the most important role equine practitioners play in disaster management is educating clients regarding disaster preparedness. They stress that effective approaches to disaster preparedness save more lives than any type of disaster response. Additionally, practitioners may play a critical role in developing local disaster response plans and setting up volunteer disaster response teams.

    How can veterinary practitioners best prepare for an animal health emergency? This question is addressed in the section "Biosecurity and bioterrorism preparedness." 

  • The article "Biological terrorism against animals and humans: a brief review and primer for action" was written shortly after the terror attacks of September 11, 2001. The validity and importance of the authors' recommendations are still evident in 2008 as preparedness planning continues to evolve. Primary among these is that veterinarians should know baseline disease prevalence and incidence rates, as these are prerequisite to any effective surveillance system. Without this information, it is impossible to tell whether disease occurrences are below or above the threshold for specialized action. Further, timely knowledge of key production variables in agricultural animals would allow early detection of adverse health events that could point to bioterrorism against animal populations. Also vital is the ability of veterinarians to recognize the signs and symptoms of the likely disease agents.
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  • The Centers for Disease Control and Prevention organizes potential agents of bioterrorism into 3 categories — A, B, and C — according to degree of risk to public health. Category A agents are those deemed most critical to public health. In "The ABCs of bioterrorism for veterinarians, focusing on Category A agents" the author familiarizes veterinarians with the clinical signs of infection in animals and humans and the zoonotic potential of microbial and viral agents most likely to be used by bioterrorists targeting humans. 
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  • Agents belonging to categories B and C are less likely to cause large-scale illness and death, but still have potential for widespread dissemination and, in some cases, massive economic disruption and large numbers of human deaths if used for bioterrorism. In "The ABCs of bioterrorism for veterinarians, focusing on Category B and C agents" the author explains what veterinarians should do if they suspect infection with these agents in an animal or human.
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  • Bioterrorism agents may be utilized in weapons of mass destruction, but other agents might be involved as well. Because of the potential for veterinarians to be involved in the response to an incident involving weapons of mass destruction, they should have basic information of the various agents that might be used. In "Awareness-level information for veterinarians on weapons of mass destruction and preservation of evidence" the author provides an overview of agents, including their mechanisms of action, related safety measures, and treatment options, as well as basics of evidence preservation for purposes of criminal investigation.
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  • In the next article, "Awareness-level information for veterinarians on control zones, personal protective equipment, and decontamination," the author further explains that all veterinarians should have an understanding of emergency response, particularly of the Incident Command System. In the event of a disaster, traditional first responders, such as fire fighters, may already be on the scene and implementing a response system and command structure as outlined in the ICS. 
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  • The authors of "Veterinary expertise in biosecurity and biological risk assessment" explain that although most veterinarians possess expertise in national biosecurity and biological risk assessment, many do not recognize they possess it or do not realize how their expertise may be applied in the areas of preparedness and response. Awareness-level information about various elements of biosecurity and risk assessment are provided.
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  • How might biosecurity planners identify the best strategy for controlling a disease outbreak before it occurs? This question is addressed in "Description of an epidemic simulation model for use in evaluating strategies to control an outbreak of foot-and-mouth disease." The authors developed a spatial epidemic model to simulate intraherd and interherd transmission of foot-and-mouth disease virus in the United States. While numerous models had been developed to simulate foot-and-mouth disease outbreaks among livestock populations in developed countries, this 2002 study was one of the earliest to simulate foot-and-mouth disease virus transmission after considering spatial proximity among herds. Control methods investigated included slaughter of all animals in the affected herd, pre-emptive slaughter beyond the affected herd, and vaccination of non-infected animals.
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    Foot-and-mouth disease virus was eradicated in the United States in 1929; therefore, current data concerning disease spread were not available. The authors explain that when information concerning likely outcomes of an outbreak is not available, a simulation model is especially useful in biosecurity planning.

    The next section, "Search-and-rescue dogs," includes commentaries and studies that illuminate the nature of the work of search-and-rescue dogs and the hazards they face. 

  • In "Search-and-rescue dogs: an overview for veterinarians" the authors present information to help veterinarians understand the background, traits, health needs, and occupational hazards specific to search-and-rescue dogs. Veterinarians may be called upon to advise regarding selection of search-and-rescue dogs, to pre-screen dogs for health conditions that may limit their working ability, to treat dogs with health issues arising from deployment, or to provide ongoing care. An understanding of the special needs of these dogs is essential to providing optimal treatment and recommendations.
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  • Search-and-rescue dogs play an invaluable role in the response to urban disasters. Urban disaster sites are potentially contaminated with many dangerous chemicals and substances, and these dogs often work in areas that are deemed unsafe for or inaccessible to human rescuers, entering disaster sites without the personal protection equipment typically worn by their human counterparts. In "General toxicologic hazards and risks for search-and-rescue dogs responding to urban disasters" the authors attempt to raise awareness among veterinarians regarding the hazards, risks, and potential problems these dogs face both during the time of exposure to urban disaster sites and during the weeks and months that follow.
  • To decrease the likelihood of a dangerous exposure for search-and-rescue dogs, it is important to have knowledge of the most common toxicologic hazards and risks and of the specific toxicologic agents. In "Toxicologic agents of concern for search-and-rescue dogs responding to urban disasters" the authors discuss some of the specific common substances that may be found at urban disaster sites and their potential for short- and long-term health effects. Hydrocarbons, including diesel fuel, jet fuel, gasoline, and asphalt, head the list owing to the large number of motor vehicles typically found in an urban disaster site. Gasoline alone may contain 150 hydrocarbon compounds. Many other toxins such as polychlorinated biphenyls, toxic metals, asbestos, cynanide and sulfide gases, acids, and alkalis are discussed as well.
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  • Provisions must also be made for prompt and appropriate treatment of dogs exposed to toxic substances in urban disasters. In "Management and prevention of toxicoses in search-and-rescue dogs responding to urban disasters" the authors describe diagnostic testing for specific toxicants, outline basic treatment of search-and-rescue dogs exposed to toxicants, and offer recommendations to minimize potential risks.
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  • Response efforts surrounding the most devastating urban disaster in US history, the attacks of September 11, 2001, involved 250 to 300 search-and-rescue dogs. In the article "Medical and behavioral surveillance of dogs deployed to the World Trade Center and the Pentagon from October 2001 to June 2002" the authors evaluated the early medical and behavioral effects of deployment to the World Trade Center, Fresh Kills Landfill, or the Pentagon on responding search-and-rescue dogs. This was done by comparing health findings for deployed dogs with findings for a second group of dogs trained in a similar manner but not deployed.
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    Mild but significantly higher serum concentrations of globulin and bilirubin and serum activity of alkaline phosphatase in deployed dogs suggested higher antigen or toxin exposure, but values for both groups were within reference ranges. The authors concluded that within the first year following the September 11 attacks, there was no evidence that responding dogs developed adverse effects related to their work. 

  • In "Deployment morbidity among search-and-rescue dogs used after the September 11, 2001, terrorist attacks" the authors describe characteristics of the responding dogs, evaluate variables associated with morbidity of the dogs, describe canine injuries and illnesses that occurred during deployment, and offer recommendations to decrease morbidity in future response efforts. Most dogs were found to have experienced injury and illness but all cases were minor. Dogs deployed to the World Trade Center were 6.6 times as likely to have one or more abnormalities, compared with dogs deployed to the Pentagon. The authors concluded that the number of morbidities found emphasized the need for veterinary care in search-and-rescue dogs.
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  • Also hard at work on September 11, 2001, was a guide dog named Roselle who skillfully guided her blind partner from his office in the World Trade Center down 78 flights of stairs after the building was struck. Roselle had been trained at Guide Dogs for the Blind, where a team of professionals including veterinarians, guide dog instructors, nurses, psychologists, and social workers contributed to her ability to serve when needed. In "The modern working dog—a call for interdisciplinary collaboration" the author explains that guide dog schools provide an excellent example of how various allied professions can work together to further enhance the human-animal bond of a working team.
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    The next section, "Preparedness and response policy," contains key information veterinarians should know about legal, legislative, and policy issues surrounding disaster preparedness and response. 
     
  • In "Organizational aspects of disaster preparedness and response" the author emphasizes that veterinarians who may become involved in the organized response to any disaster or emergency must understand the basic concepts and components of the Incident Command System, a component of the National Response Plan. The ICS provides for coordination of personnel, equipment, and other resources at the scene of a disaster. Also the National Response Plan stipulates that if a local emergency operations center is capable of managing a particular incident, higher levels such as the federal government do not need to be involved. Therefore, each state is expected to plan for and respond to incidents within their scale of emergency operations.
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  • The article "Veterinary legal issues: 2006 in review" devotes a section to key legal developments in the management of animals in natural disasters. The authors explain that in addition to a number of new state laws that address this issue, the federal Pet Evacuation and Transportation Safety Act of 2006 requires state and local emergency preparedness authorities to include in their evacuation plans information on how they will accommodate household pets and service animals in case of a disaster.
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  • The Gulf Coast hurricanes of 2005 called attention to one of the most important problems associated with natural disasters: that preplanning failed to take into account the human-animal bond. The American Veterinary Medical Association recognized that it could facilitate a meeting of all groups involved in animal disasters, allowing those actually involved in relief efforts to identify roadblocks to their efforts and collectively find ways to address those problems. The "Report of the 2006 National Animal Disaster Summit" details findings and recommendations from this meeting. Key findings were that lack of coordination and control of response activities were the most significant problems encountered by emergency workers and that animals must be included in disaster planning.
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    These highlights reflect some of the information to be found in the AVMA Collection "Disaster preparedness and response." We hope you find this resource useful as you address disaster planning in your practice and your community.

    To learn more about the National Response Plan and Incident Command System, visit the FEMA ICS Resource Center at:
    www.training.fema.gov/EMIWeb/IS/ICSResource

    More disaster preparedness resources can be found on the AVMA Web site at:
    http://www.avma.org/disaster