By Noah Smith
Hurricane Ian reached Category 5 strength earlier today, with winds in excess of 100 mph off Florida’s west coast.
Several federally qualified health centers (FQHCs), which provide primary preventive care to anyone regardless of ability to pay, stand in Ian’s planned path. Over 1 million patients are currently on Ian’s path. For many people, FQHCs are their only source of health care, with the exception of emergency departments—which is also the case during and after natural disasters.
“In many communities after a hurricane, the local private sector will not be ready to open their doors. FQHCs have a mission to promptly meet the needs of their community. They need to be open immediately if people need a place to go … for the uninsured and the elderly, that’s the only place to go, except for the emergency room, which is the worst place,” Andrew Berman said. , president and CEO of the Florida Association of Community Health Centers, which counts 54 FQHCs among its members.
Berman, who has more than 20 years of experience in his role, said the combination of high costs, long wait times and the diversion of limited resources makes the post-hurricane emergency room a suboptimal choice for non-emergency care. Â
Before the storm, Berman said FQHCs in Florida are currently focused on keeping staff and patients safe from harm. He said most would be closed today and possibly tomorrow, mainly due to the evacuation of patients.
“We encouraged those in the evacuation zone to get out of there,” Berman said, adding that clinics used “every tool they could,” including emails, text messages, Facebook and personal phone calls, to inform patients they were evacuating. “I’ve lived in Florida for over 60 years and the last thing you want to do is be in the path of a Category 4 or 5 storm,” he said.
FQHCs in Florida also test generators and coordinate details to liaise with the local and state emergency operations center as well as Behrman’s organization — one of the most critical aspects of disaster response and recovery, Behrman said. To ensure constant communication, FHQCs in the path of the hurricane have received satellite phones. There are also plans to set up “MASH” style tents so people can be treated even if a building is put into service, along with generators and washing stations shortly after the storm passes. These purchases were made possible by a Direct Aid grant.
Although not designed for emergency care, FQHCs are also prepared to stabilize acute trauma patients before taking the patient to an appropriate facility, Berman said, again noting that communication, in this case with a local acute care center, is vital.
Offering continuity of care, especially for chronic conditions, has proven critical since the hurricanes.
A multi-decade study published in JAMA found a 33.4 percent higher death rate after major hurricanes in the United States. Increased mortality rates are observed for causes of death such as injuries, infectious and parasitic diseases, respiratory diseases, cardiovascular diseases and neuropsychiatric diseases. No increases in deaths due to cancer were observed.
During disasters and everyday life, certain groups are more vulnerable to adverse health effects. Age, income, and the presence of disability, along with other social determinants of health, are associated with poorer health outcomes, which may be magnified during natural disasters when interruptions in care are more likely to occur—which makes more difficult to obtain medicines and supply medical devices.
Â Of the 1.05 million patients at a federally qualified health center in the path of the hurricane, according to a Direct Relief analysis of U.S. Health Resources and Services Administration data, about 11 percent are under the age of six, 50 percent live in the federal at or below the poverty line, 18% have hypertension, 31.5% are classified as overweight, 4% have asthma and 8% have diabetes. More than 20% of patients speak a language other than English.
In Pinellas County, 25% of the population is over the age of 65, which is 8.5% higher than the US national average of 16.5%. Hillsborough County’s population is younger than average, but 14 percent of the population lives below the poverty line, compared to the national average of 11 percent.
Both counties, which are the two most populous counties on the Gulf Coast in Hurricane Ian’s projected path, have about 18,000 people with power-dependent medical devices. The national average per county is 895 people. A 2010 study found that the average backup battery for an intensive care ventilator lasts between about 20 and 170 minutes.
Earlier this summer, in accordance with a program created in 2007 that began after Hurricane Katrina to help support FQHCs, Direct Relief pre-positioned a dozen hurricane preparedness packages in Florida. The packs, which contain over 210 different products and have been refined and updated based on feedback from FQHCs and other health care providers, currently have an array of antibiotics, syringes, basic first aid supplies and medications for conditions such as diabetes, hypertension and severe allergic reactions. One of the recipients this year was Tampa Family Health Center, one of the largest federally qualified health centers in Florida.
Berman said that as the storm approaches and the mission moves from evacuation to reopening, his organization and the FQHCs it supports will remain focused on the stakes affected.
“At the end of the day, we might be the only option for people,” he said.