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How Public Health and Law Enforcement Agencies Work Together: a Discussion of the
April, 2011 Tornado Outbreak in the American Southeast
Dr. Joseph Costa, D.H.Sc., PA-C
Health Policy and Management
MPH 525
Diana Pinney
April 2013
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Table of Contents
Chapter
Page
1. Introduction………………………………………………………………...…...………3
Measuring the Devastation………………………………………………….…….3
Destruction Caused and Public Health Hazards Created……………………….....4
2. Involvement of Agencies…………………………………………………………….....4
Volunteer Agencies……………………………………………………………......5
Function of Public Health Agencies……………………………………………....6
Role of Federal Government………………………………………………….…...6
Role of State and Local Governments………………………………………….....7
3. Preparedness Improvements…………………………………………………………....8
Challenges……………………………………………….……………………..….8
What Went Right?....................................................................................................9
What Went Wrong?...............................................................................................10
Are Current Policies Sufficient?............................................................................11
4. Summary, and Recommendations…………………………………………………….12
Summary…...…………………………………………………………………….12
Recommendations……………………………………………..…………………12
References………………………………………………………………………………..14
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Chapter 1
How Public Health and Law Enforcement Agencies Work Together
Introduction: The April 25-28, 2011 Tornado Outbreak
Between April 25 and 28, 2011, 358 tornadoes spread throughout 21 states
touched down in the southeastern United States (Samenow, 2012). Collectively, these
tornadoes travelled 2,600 miles (Samenow, 2012). April 27 was the most violent and
deadly day of this extreme weather episode as 122 tornadoes in Mississippi, Alabama,
Tennessee, Virginia, and Georgia killed 316 and injured over 2,400 people (Hayes,
2011).
Measuring the devastation.
In order to place into context the complete devastation of these 4 days, most
notably April 27, the tornadoes themselves are discussed here.
The ‘violence’ of a tornado is measured on the Enhanced Fujita Scale and given
ratings of F0-F5 (National Oceanic and Atmospheric Administration [NOAA, 2011]). An
F4 tornado is labeled “devastating” and has wind speeds of over 208 miles per hour. An
F5 is called “incredible,” with sustained wind speeds of over 261 miles per hour (NOAA,
2011).
Of the 122 tornadoes that met the Earth on April 27, 15 were rated either F4 or F5
(Hayes, 2011). Eight of these 15 tornadoes each travelled over 50 miles (Hayes, 2011).
The super-storm that created the tornado outbreak was forecast five days before it
started by the National Weather Service’s (NWS) Storm Prediction Center (SPC) (Hayes,
2011). Weather Forecast Offices (WFO) in Tennessee, Mississippi, Alabama and Georgia
began preparing their residents for extreme weather and continually updating the
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situation (Hayes, 2011). Regardless of the preparations, policies and collaborations that
did or did not work, this tornado outbreak was the most expensive in United States
history. Monetarily, it cost the US $11 billion, but the cost of this event cannot be tallied
solely in dollars (Samenow, 2012).
Destruction caused and public health hazards created.
When a house, neighborhood or entire town is destroyed, the lingering
psychological effects of trauma on the witnesses and survivors (especially children and
those who work with children) are high on the list of public health priorities (Alabama
Department of Mental Health [ADMH], 2011).
Physical hazards that first responders, volunteers, and victims were subjected to in
2011 include heat and emotional stress or harm from unstable rubble (South Central
Preparedness and Emergency Response Learning Center [SCPERLC], 2011). Other
public and environmental health hazards brought on by these tornadoes include chemical
or electrical exposure due to standing or contaminated water, dust inhalation and illness
due to bad food or water (SCPERLC, 2011).
Chapter 2
Involvement of Agencies
Agencies involved in addressing the lead up and aftermath of this storm include,
the Centers for Disease Control (CDC), the NWS (a function of NOAA), the Federal
Emergency Management Agency (FEMA), and the American Red Cross. Many local
and regional WFOs and SPCs performed spot forecasting, weather predictions, and
compiled data.
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Volunteer Agencies
The American Red Cross was the most recognizable and influential volunteer
organization to involve itself in the aftermath of the tornado disaster of 2011. Many
community organizations rushed to aid the people of Alabama and surrounding areas but
their efforts were structured and deployed by the American Red Cross (American Red
Cross [ARC], 2011). Under the direction of the ARC, these organizations assisted with
feeding and housing tornado victims, tarping roofs, directed caseworkers to those in need
and disseminated information on other services available (ARC, 2011).
FEMA recommends that those who wish to volunteer to assist people and areas
affected by disaster either donate to volunteer organizations or join an organization that
has already begun relief work (FEMA, 2013). This advice is given to prevent any
obstruction or interference from well-meaning people. Possible obstructions to disaster
relief efforts include people showing up unprepared and needing to be fed, housed, and
medically cared for, or burdensome shipments of unnecessary items. This “misdirected
compassion can actually tax scarce resources, costing time, money, energy – and lives”
(Aleccia, 2010).
Dr. Krisi L. Keonig specializes in disaster response (Aleccia, 2010). She
recommends, “Unless you’re part of a team before the disaster happens with a formal
mission, you’re going to be part of the problem” (Aleccia, 2010).
Based on the information from these experts, the author could not find any
specific documentation of volunteers or organizations hindering the relief effort. That is
not to say that piles of donated items did not flood into communities and cause
unnecessary work. But, in general it is reported that the organized response and the
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ARC’s oversight seems to only have helped the clean up and recovery process of this
disaster.
Function of Public Health Agencies
Role of the federal government.
The federal government’s official role in preparing for and responding to national
disasters involves providing a baseline of emergency management standards for states,
and assisting states with emergencies when called upon (Mississippi State Department of
Health [MSDH], 2012).
There are initiatives from federal agencies that provide structure to states and
localities for disaster readiness. For example, the CDC provides the National Standards
for State and Local Planning and the US Department of Health and Human Services
(HHS) has written the Cities Readiness Initiative (MSDH, 2012). Additionally, the
NOAA’s National Weather Service has a program called, ‘StormReady.’ As a function of
the federal government, it “helps arm America’s communities with the communication
and safety skills needed to save lives and property-before and after an event” (NOAA,
2013).
The federal government’s role in the response to the April, 2011 tornadoes can be
summed up by simply saying it learned a lot from mistakes made in dealing with
Hurricane Katrina. Reports from residents and local officials of the federal government’s
response and timeliness are generally positive. As there was learning from the
experience of Hurricane Katrina, there is also room for learning from this crisis.
According to Sack and Williams (2011), FEMA was ahead of the state of
Alabama in addressing the need for a declaration of federal emergency. When
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interviewed by Sack and Williams (2011), residents declared that effective action had
been taken to feed, clothe and house them. Most complaints surrounded the inability to
go back to their homes and of traffic snarled by debris clogged roads or lack of electricity
(Sack & Williams, 2011).
Role of state and local governments.
The role of state and local governments during and directly after this weather
crisis were arguably the most negatively and positively influential of any group involved.
State and local governments were also the two groups to work most in concert with each
other, although most often under standards set by the federal government.
Not all states have local or regional public health departments, but “following a
disaster, local public heath authorities have the primary responsibility for the health of a
community” (Landesman, 2006, p. 7). Local and state emergency management
authorities are tasked with formulating a disaster plan and calling for federal assistance if
needed (Landesman, 2006).
There are many preparedness functions that states undertake in the American
southeast. Conditions to prepare for include floods, tornadoes and lighting storms. Under
federal supervision by the NWS, states and local WFOs have “aggressive pre-season
preparedness activities” (Hayes, 2011, p. 10). Region specific brochures are handed out
while the media presents exhibitions surrounding weather hazards. These efforts are part
of a yearly February event called, ‘Severe Weather Awareness Weeks’ (Hayes, 2011).
Local WFOs also participate in county sponsored and organized weather spotting
training called SKYWARN (Hayes, 2011).
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Directly after the storm events of April 2011, the Mississippi State Department of
Health (MSDH, 2012) deployed the Mortuary Response Team and Disaster Medical
Transport Operations. In Alabama, the public health emergency response included
nurses, mobile hospitals, pharmacies, and water purification units (Alabama Department
of Public Health [ADPH], 2011). These state departments coordinated with local (if
present) emergency disaster preparedness teams and their respective procedures (ADPH,
2011).
Chapter 3
Preparedness Improvements
Challenges
When linking mortality data to Global Imaging System (GIS) data of the April,
2011 tornado tracks, Merzlufft, Noe, Hallisey, and Wellman (2012) found not only
interagency inefficiencies, but also social factors that increased mortality during this
event.
Merzlufft et al. (2012) found that information regarding the tracking and
characteristics of the tornadoes did not match up across WFOs, county, or state lines.
Different jurisdictions also have different tornado naming conventions and ways of
noting the date and time (Merzlufft et al., 2012). Merzlufft et al. (2012) found that these
discrepancies, if standardized, could lead to ease of communication across borders and
between agencies. Merzlufft et al. (2012) also found room for improvement on
communication and cooperation between the different levels of public health and safety
agencies so more precise information could be shared quickly.
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What Went Right?
Every single death that occurred in these four days were “within the boundaries of
tornado watches and were preceded by tornado warnings” (Hayes, 2011, p. 1). Five days
before any tornadoes touched down, local WFOs were updating their websites’
‘Hazardous Weather Outlooks,’ hosting webinars that described possible effects of the
storm and updating the press with briefings (Hayes, 2011).
Many communities and universities in the tornado-affected area had been trained,
prepared and declared to be ‘StormReady’ by the NWS (Hayes, 2011). “All counties
where F4 or F5 damage occurred had achieved the StormReady designation” (Hayes,
2011, p. 11).
Hayes (2011) also found that weather forecasting offices were in effectual
communication with the local first responders and school administrators.
According to the Tornado Recovery Action Council (TRAC, 2012), electrical
infrastructure and buildings stood up to the onslaught well as “the result of sound
construction methods” (p. 29).
What Went Wrong?
Many ways in which people are vulnerable to tornadoes are directly linked to
socioeconomic status (Merzlufft et al., 2012). The nature of this storm was rare. The
intensity of the storms, their occurrence in highly populous locations and their speed of
travel not only lessened the time people had to escape, but created many densely packed
fatalities (Hayes, 2011). Some people waited until they could see a tornado to take shelter
or waited until warnings were broadcast by two sources. Some houses and whole
communities did not have proper storm shelters (Hayes, 2011). There is obviously a
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significant breakdown in the many efforts to create a knowledgeable, storm-ready
community, especially for those susceptible to the most fatalities, many of whom are
older and live in mobile home parks (NOAA, 2013).
In Alabama, most of the tornado deaths were individuals older than 65 who “had
a social or physical vulnerability” (Chiu et al., 2012, p. 70). Most deaths and injuries
were due to head trauma in individuals living in mobile homes (Chiu et al., 2012). Postdisaster statistics have continually told authorities where and who the most vulnerable to
these kinds of weather events are, yet the most vulnerable still ignore the sirens.
On the policy level, emergency managers think that the expansion of weather
awareness weeks is “diluting the messages and causing the events to lose their
effectiveness” (Hayes, 2011, p. 10).
Even though it was the opinion of the TRAC that electrical systems held up well,
some systems did fail which affected communications and sirens (TRAC, 2012). During
the storm, three (one in Tennessee, two in Alabama) Doppler radars failed (Hayes, 2011).
two of the radars were able to be fixed, but one remained unusable which “affected the
Chattanooga-area media’s ability to broadcast precise information regarding tornado
locations” (Hayes, 2011, p. 14).
Though WFOs in the southeast participate in weather spotter training, “this
training is not provided uniformly to all counties” (Hayes, 2011, p. 10). Some WFO
employees were found to have had no training in two years (Hayes, 2011). Inside the
WFOs themselves, the offices are arranged in a way that creates an impasse between
workstations and employees’ ability to monitor the constantly updating situational
awareness displays (SAD) (Hayes, 2011).
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Are Current Policies Sufficient?
Current policies are not sufficient. It seems the response in the aftermath of this
disaster was well organized, timely and effective, but many policies governing
emergency action during the storm could be strengthened.
Many critiques of intergovernmental efficacy are based on communication and
standardization, and this is also one of them. Unfortunately, ease of interagency
communication and standardization is one of the detriments of state autonomy. The many
programs and agencies created to suit each county or state may not have context in
another. Regardless, the ability of WFOs to function properly, interface digitally or
communicate via standardized technology and protocol is a much-needed current policy.
Sharing data and corroborating weather locations is a must. The challenges Merzlufft et
al. (2012) met in trying to gather cohesive GIS data should never happen again. Doppler
radar should not fail to the point that it affects tracking tornadoes during a giant, deadly
storm. Populations already deemed vulnerable to the effects of extreme weather should
not perish in concentrated groups nor should individuals be without proper emergency
shelter (TRAC, 2012).
Another insufficiency of high importance is the considerable amount of time
between when a disaster occurs and the enactment of policy improvements (Auf der
Heide, 1989).
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Chapter 4
Summary and Recommendations
Summary
In general, the local, state and national public health response to the aftermath of
the April, 2011 tornado outbreak was effective. The systemic breakdowns of weather
forecast spotter trainings, electrical infrastructure, community safety measures and
responses to warnings came at the state level, and should be addressed thusly.
It is the author’s belief that since the April 2011 tornado outbreak was the most
significant national disaster since 2005’s Hurricane Katrina, the federally coordinated
intergovernmental response and efforts were highly influenced by the many publicized
failures of its response to that event. The federal government’s overall attentiveness and
efficacy is evidenced by FEMA being the first agency to call for a state of emergency in
Alabama. There is also no discernable evidence located by the author of failure on the
federal level found by investigators and participants in the response to the tornadoes. All
critiques and recommendations are aimed at states or localities that failed in
communicating across jurisdictional lines, data collection, infrastructure support, and
community safety organizing.
Recommendations
In order to be able to properly reflect on the effects of emergency management
policy regarding public health and safety, there must be accurate and comprehensive data
to analyze. Nationwide standardization of data collection and weather prediction
programs seems a very basic and highly impactful place to start. According to Auf der
Heide (1989), and data collection issues discussed previously, reports of disasters are
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often incomplete and contain inaccurate information. Many reports are not objective or
lack continuity (Auf der Heide, 1989). Since technology has come far since these
recommendations were made in 1989, perhaps there is now a feasible way to provide
investigators a standard, portable documentation system such as a tablet device.
The most common cause of death during this event was head injury to older
people. This factor should be taken into account by emergency response policy writers,
personnel, and hospitals making plans for disaster surges.
If emergency managers think that too many preparedness brochures and activities
are dumbing down the message, then perhaps less would be more if 2 or 3 big events
could disseminate a more concentrated message. This message could be concentrated in
locations that are continually battered by tornadoes such as areas with dense populations
or an abundance of mobile homes. Just as many neighborhoods have a coffee shop or
post office, they should also have a storm shelter that everyone is familiar with.
In short, preparedness policies, data sharing, data collection, and technological
platforms should be standardized. Weather and warning systems should be made more
reliable and predictable. Emergency shelters should be made easily accessible while
outreach is focused on the most vulnerable populations.
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References
Alabama Department of Mental Health. (2011). April 2011 tornado outbreak. Retrieved
from http://www.mh.alabama.gov/COPI/TornadoCrisis.aspx
Alabama Department of Public Health. (2011, October 26). Public health tornado
response. Retrieved from
http://www.adph.org/ALPHTN/assets/102611HatchHandouts.pdf
Aleccia, J. (2010, January 23). Disaster do-gooders can actually hinder help. NBC
News. Retrieved from http://www.nbcnews.com/id/34958965/#.UV9GzqV0G0s
American Red Cross. (2011, May 20). Press release: Red Cross brings comfort and food
to people of Alabama. Retrieved from
http://newsroom.redcross.org/2011/05/20/press-release-red-cross-brings-comfortand-food-to-the-people-of-alabama/
Auf der Heide, E. (1989). Disaster response – principles of preparation and
coordination. Center of Excellence in Disaster Management & Humanitarian
Assistance. Retrieved from http://coe
dmha.org/Media/Disaster_Response_Principals.pdf
Chiu, C. H., Schnall, A., Vagi, S., Noe, R., Merzlufft, C., Spears, J., Casey-Lockyer, M.,
& Wolkin, A. (2012, April). Mortality in tornado outbreak – Alabama, 27 April
2011. Epidemic Intelligence Service. Retrieved from
http://www.cdc.gov/EIS/downloads/2012.EIS.Conference.pdf
Federal Emergency Management Agency. (2013). Volunteer & donate responsibly.
Retrieved from http://www.fema.gov/volunteer-donate-responsibly
Hayes, J. L. (2011, December). Service assessment: the historic tornadoes of April
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2011. The National Oceanic and Atmospheric Administration. Retrieved from
http://www.nws.noaa.gov/os/assessments/pdfs/historic_tornadoes.pdf
Landesman, L. Y. (2006). Public health management of disasters: the pocket guide.
American Public Health Association. Retrieved from
http://www.apha.org/NR/rdonlyres/ECDFA2EC-49A0-4D7A-B2571488E671DE5B/0/APHA_DisasterBook_2.pdf
Merzlufft, C., Noe, R., Hallisey, E., & Wellman, M. (2012, March 1). GIS mapping the
NWS tornado tracks and public health mortality data from the 25-28 April 2011
tornado outbreak. Department of Health and Human Services. Retrieved from
http://www.norman.noaa.gov/nsww/wpcontent/uploads/2012/03/Mertzlufft_NSWW2012.pdf
Mississippi State Department of Health. (2012). Emergency preparedness overview and
response efforts. Retrieved from
http://msdh.ms.gov/msdhsite/_static/resources/4778.pdf
National Oceanic and Atmospheric Administration. (2013). StormReady. Retrieved
from http://www.stormready.noaa.gov
National Oceanic and Atmospheric Administration. (2011). The enhanced Fugita scale.
Retrieved from http://www.spc.noaa.gov/efscale/
Sack, K. & Williams, T. (2011, April 30). Government’s disaster response wins praise.
The New York Times. Retrieved from
http://www.nytimes.com/2011/05/01/us/01fema.html?pagewanted=all&_r=0
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Samenow, J. (2011, April 27). Super tornado outbreak of April, 2011: one year
anniversary. The Washington Post. Retrieved from
http://www.washingtonpost.com/blogs/capital-weather-gang/post/super-tornadooutbreak-of-april-27-2011-one-yearanniversary/2012/04/27/gIQARRLJlT_blog.html
South Central Preparedness and Emergency Response Learning Center. (2011). Putting
CPHP/PERLC training to the test: the Alabama tornado response. Retrieved from
http://dev.phprep.org/2012/agenda/upload/H-01-Improving-Communications-andEnhancing-Trainings-for-Planning-Preparedness-5-2.pdf
Tornado Recovery Action Council. (2012, January). Cultivating a state of readiness: our
response to April 27, 2011. Retrieved from
http://ema.alabama.gov/filelibrary/TRAC_Report.pdf