title: Public Health System Response to Extreme Weather Events.
abstract: BACKGROUND
  Extreme weather events, unpredictable and often far-reaching, constitute a persistent challenge for public health preparedness.
  
  
  OBJECTIVE
  The goal of this research is to inform public health systems improvement through examination of extreme weather events, comparing across cases to identify recurring patterns in event and response characteristics.
  
  
  METHODS
  Structured telephone-based interviews were conducted with representatives from health departments to assess characteristics of recent extreme weather events and agencies' responses. Response activities were assessed using the Centers for Disease Control and Prevention Public Health Emergency Preparedness Capabilities framework. Challenges that are typical of this response environment are reported.
  
  
  METHODS
  Forty-five local health departments in 20 US states.
  
  
  RESULTS
  Respondents described public health system responses to 45 events involving tornadoes, flooding, wildfires, winter weather, hurricanes, and other storms. Events of similar scale were infrequent for a majority (62%) of the communities involved; disruption to critical infrastructure was universal. Public Health Emergency Preparedness Capabilities considered most essential involved environmental health investigations, mass care and sheltering, surveillance and epidemiology, information sharing, and public information and warning. Unanticipated response activities or operational constraints were common.
  
  
  CONCLUSIONS
  We characterize extreme weather events as a "quadruple threat" because (1) direct threats to population health are accompanied by damage to public health protective and community infrastructure, (2) event characteristics often impose novel and pervasive burdens on communities, (3) responses rely on critical infrastructures whose failure both creates new burdens and diminishes response capacity, and (4) their infrequency and scale further compromise response capacity. Given the challenges associated with extreme weather events, we suggest opportunities for organizational learning and preparedness improvements.
authors.affiliation: Center for Infectious Diseases & Emergency Readiness/Cal PREPARE, School of Public Health, University of California, Berkeley (Drs Jennifer Hunter and Aragón, Ms Yang, and Messrs Mark Hunter and Crawley); Health Services and Policy Analysis, University of California, Berkeley (Mr Mark Hunter); and City & County of San Francisco, and Department of Public Health, Population Health Division, San Francisco, California (Dr Aragón).
authors.forename: Mark D
authors.initials: MD
authors.lastname: Hunter
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hunter
authors.forename: Jane E
authors.initials: JE
authors.lastname: Yang
authors.forename: Adam W
authors.initials: AW
authors.lastname: Crawley
authors.forename: Tomás J
authors.initials: TJ
authors.lastname: Aragón
mesh_terms: D004189:Disaster Planning; D006801:Humans; D007407:Interviews as Topic; D011634:Public Health; D036301:Qualitative Research; D014481:United States; D014887:Weather