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Plan for the bottom of the iceberg

Al Jazeera reported this morning that two people have died and 568 non-fatal cases of Cholera have been reported in the earthquake-hit areas of northwestern Syria. Certainly not earthquake related, but now a part of the response that needs to be considered.

One disaster piling on top of another (pardon the poor pun) is not new to history, but because it is rarely considered beforehand, I felt it deserved some attention.


During the 1811-1812 New Madrid Earthquake in the central United States, the death toll was not as high as an earthquake in the same location would be today, but the number of deaths due to the winter season at the end of 1811 is unknown but is assumed to be much higher than the original death toll from the earthquake itself. You see, the earthquake occurred in the fall when the weather in Missouri and Kentucky is rather balmy and enjoyable but the result of destroyed and unstable homes forced the population of the region into sleeping in makeshift poorly insulated shelters.


In Syria, the destruction of infrastructure, water and sewage lines after the earthquake has increased the possibility of an outbreak of the disease which was actually already spreading back in September throughout the area.


A second earthquake worsened conditions in refugee camps in the area, which already lacked sanitation and access to clean water. Combining the lack of infrastructure with the close-quarters sheltering of thousands and Cholera will not be the only disease to arise from the earthquake’s ashes.


This is not some “third world” scenario nor is it limited to more primitive times like 1811 in Kentucky.

Joplin, MO Tornado

Compounded disasters are the norm and need to be taught as such. There should never be a plan for a tornado strike that does not include a deep freeze in the immediate wake of the outbreak as we saw in Northern Illinois several years ago.


Normally, “tornado weather” is warm, humid and sticky so planning is based on the assumption that response will deal with warm summer weather. Unfortunately, tornadoes are often caused by cold fronts and drastic drops in temperatures can immediately follow a tornado although we never write our plans that way.


Just a few weeks ago, tornadic storms battered the Northern Plains and Midwest leaving more than 300,000 homes and businesses without power. These storms were immediately followed by a deep freeze and even snow.


I remember my team gearing up for Hurricane Sandy in 2012. At that time in my career, I knew how to pack for a hurricane…sturdy boots, lots of socks and underwear, lightweight shirts and sunscreen. If you have ever been in the wake of a hurricane you know that the humidity is brutal and the heat can be deadly.


Yep...Not always.


As I said, I remember the team packing for Sandy. What did NOT get packed was snowsuits, snow boots, insulated gloves, heavy face masks and space heaters.


Super-storm Sandy is one of the most infamous hurricanes in recent history, a historic weather system that left millions in the dark, caused billions of dollars in damage and set the bar for what is the worst-case scenario for a land-falling tropical system in the mid-Atlantic region. She did not stop there but chose to bring with her one massive and historic blizzard.

Not your normal hurricane response photo!

This was the first time in recorded history that the National Hurricane Center had ever mentioned SNOW and BLIZZARD CONDITIONS in one of its TROPICAL FORECASTS!


Compounded or cascading disasters are not limited to weather or small outbreaks either. For those of you that know my story or have heard me speak at a conference, you know that the cascading disasters of the Joplin tornado changed my life. In the aftermath of the Joplin tornado, some people injured in the storm developed a rare and sometimes fatal fungal infection so aggressive that it turned their tissue black and caused mold to grow inside their wounds.


This phenomena is so uncommon that even the nation’s largest hospitals may see one or two cases of this per year and the CDC stated that they had “never before seen a cluster like this in medical history”. The infection resulted in deaths but primarily caused a host of other ailments that have led to lifelong disabilities.


Following Hurricane Harvey’s arrival to Port Arthur, Texas, it did not take long for reports to start coming in regarding Staphylococcus aureus and Vibrio vulnificus as well as various diarrheal diseases and vomiting among evacuees. It is no wonder as Hurricane Harvey was the king of cascading disasters. I remember the two explosions that began to reveal that high water was not going to be the main concern for our team.

Arkema Plant explosion August 2017

The two explosions took place at a chemical facility full of peroxides. While the company had warned that explosions could be imminent, and county officials had already ordered the evacuation of people within 1.5 miles, there was no place for many to go and so we watched as smoke filled the air causing respiratory and skin irritation along with nausea and dizziness. The initial symptoms gradually diminished after a few weeks but gave way to more serious health issues caused by the plumes.


When it comes to the term “cascading” I guess we could say that the word means “adding insult to injury”. As it turns out, as the storm approached, energy companies began shutting refineries to protect their operations—emitting toxic gases in the process. Facilities have reported releasing more than 2 million pounds of hazardous chemicals into the air as the winds of Harvey picked up.


In one of the largest releases, the Chevron Phillips Chemical Cedar Bayou plant estimated that it emitted 28,505 pounds of benzene, a carcinogen, as part of its total release of more than 750,000 pounds of hazardous chemicals. Want proof? Sorry, although members of my team still struggle with health issues caused by these releases, State officials apparently “shut down” air monitors in the area “to protect them from the storm”.


Over one dozen Superfund Waste sites were compromised into the flood waters in which responders and evacuees both were wading in. Add in the heat strokes, illnesses, injuries and mental health issues and the hurricane itself was really not that big of a deal by comparison.


Nobody has a crystal ball and so nobody can look directly into the future and tell you that the next hurricane will cause a wave of Dengue brought on by a massive mosquito swarm that follows the storm due to temperatures and standing flood water. Nobody can tell you that today’s Texas tornado will compromise a hospital and send biological waste and surgical instruments out into the debris piles. If we had that crystal ball I would not be sick today nor would thousands of others.

Because there is no crystal ball, we have to opt for the best way to see into the future and that is to look backwards into history. The flu that followed Hurricane Sandy was the same as the flu that followed Saxby’s superstorm in 1865 that struck New Jersey over 100 years earlier. The lead chaff issues following the Joplin tornado had actually been experienced in Oklahoma and Ohio years earlier.


History holds the keys that today’s emergency managers and responders need to make the right decisions and to create truly comprehensive plans. Again, if you know me or follow this blog because you have heard me speak or have read my book, you know that I move forward in confidence because I know my history. You can too.


Entropy is a scientific concept, as well as a measurable physical property, that is most commonly associated with a state of disorder, randomness, or uncertainty. The term and the concept are used in diverse fields, from classical thermodynamics where it was first recognized to the microscopic description of nature in statistical physics and to the principles of information theory.

Too much? I was just trying to sound smart.


Entropy is Murphy’s law. Entropy is a reality of physics. All things in nature and human systems have a tendency to breakdown. This is nature’s way of seeking balance. It’s not a matter of “if” the unexpected will happen, it’s a matter of when! In other words, Anything that can go wrong will go wrong.


Time to rewrite a few plans. The icebergs tend to be bigger on the bottom…

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