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Rural Health Information Hub

Accessing Emergency Preparedness and Response Resources for Rural Communities

Date:
Duration: approximately minutes

Featured Speakers

Daniel Green Daniel Green, Region 8 Resilience Analyst, National Preparedness Division, Federal Emergency Management Agency (FEMA)
Jeff Hoogheem Jeff Hoogheem, Director of the Center for Health Emergency Preparedness and Response (CHEPR), Texas Department of State Health Services
Grant Brown Grant Brown, Director of Recreation and Cultural Affairs and Public Information Officer (PIO) for the City of Gulf Shores, Alabama

Last in a 3-part webinar series on rural emergency preparedness and response. This webinar will share local, state, and federal perspectives on how rural communities can access needed resources when responding to and recovering from a disaster or emergency.

Hear from a Federal Emergency Management Agency (FEMA) Resilience Analyst working with state, local, and tribal emergency preparedness professionals in Colorado, Montana, North Dakota, South Dakota, Utah, and Wyoming to better prepare, respond, and recover from disasters. The Director of the Center for Health Emergency Preparedness and Response (CHEPR) at the Texas Department of State Health Services will share experiences working with and forming partnerships with rural communities and federal partners to access resources for emergency preparedness, response, and recovery. Also, learn how the City of Gulf Shores, Alabama built on lessons learned from previous disasters to plan for and fund their response and recovery efforts after a hurricane, including how they budgeted for recovery efforts and worked to navigate and obtain FEMA reimbursement. This webinar and the related Rural Emergency Preparedness and Response Toolkit, were supported with funding from the Centers for Disease Control and Prevention (CDC).

Case study featured in this webinar:

From This Webinar


Transcript

Kristine Sande: Good afternoon, everyone. I'm Kristine Sande, and I'm the program director of the Rural Health Information Hub. I'd like to welcome you to today's webinar on accessing emergency preparedness and response resources for rural communities. I'd like to thank the Centers for Disease Control and Prevention for funding this webinar, as well as our work to develop the Rural Emergency Preparedness and Response Toolkit, which you can find on the RHIhub website. Now, I'll quickly run through a few housekeeping items before we begin. We've provided a PDF copy of the presentation on the RHIhub website, and that's accessible through the URL that's on your screen.

Now, it's my pleasure to introduce our speakers for today's webinar. Daniel Green is our first speaker and he currently serves as a Resilient Analyst in the National Preparedness Division at the Federal Emergency Management Agency, otherwise known as FEMA in Region 8. He focuses on providing qualitative and quantitative analysis on socioeconomic determinants of preparedness across the Mountain West in Northern Great Plains, and serves as the dedicated liaison for colleges and universities in Region 8. He holds a Master's in International Studies from the University of Denver and has previously worked on diplomatic missions for the North Atlantic Treaty Organization as well as Canada and Norway.

Jeff Hoogheem is the Director of the Center for Health Emergency Preparedness and Response at the Texas Department of State Health Services. He serves as the Incident Commander in the Texas State Medical Operations Center, and he's responsible for coordinating all public health and medical preparedness and response activities in Texas. He has played critical roles leading the response to all major incidents in Texas since 2009, including the state response to H1N1 influenza, the West Fertilizer Plant explosion, the 2014 Texas response to Ebola, the Zika Virus response, Hurricane Harvey, and COVID-19.

Our final presenter is Grant Brown. He has served as the Recreation and Cultural Affairs Director and Public Information Officer for the City of Gulf Shores, Alabama, since 2009. His daily responsibilities include recreation and sports programming, special events, parks and facilities management, library and museum operations, and communications for the city. During a disaster, he focuses full-time on communicating community preparedness, response, and recovery messages to residents and visitors. At this point, I will turn it over to Daniel.

Daniel Green: Thank you so much. It's an honor to be joining everyone here today. I want to begin by saying that it's an honor to be on such a prestige panel and speaking on such an important topic today. I, in some regard, have a little bit of an imposter syndrome, understanding probably some of the things I'm saying today I'm preaching to the choir. Your service, your skill, your acumen from working in the field on these sorts of areas, rural health, rural preparedness, you're doing an amazing line of effort out there. What my grandma used to have said would've been, "You're doing the Lord's work." Funny she never really clarified what that work was or how she ever knew that, but we always understood that we were doing a good thing for good people.

I want to talk today about a couple of broader understandings and shifts in understanding how rural preparedness works, a multidimensional aspect to it, and share a tool that was developed, in addition to the fantastic tool that was just shown, the CDC-developed tool for rural preparedness, and that's FEMA's Resilience Analysis Planning Tool. I'll drop the link in the chat in just a moment and show it, but first, I want to begin by saying working in Region 8, which includes North Dakota, South Dakota, Montana, Wyoming, Colorado, and Salt Lake is defined by its rurality, if that's a word. If not, maybe we can trademark it together.

Once you get outside of the Denver metro area, in Colorado Springs and Salt Lake City, the American West, the mountains and the Northern Great plains are defined so much by who isn't there as who is there, and those that live there are usually living on the fringes of what we would probably think of as modern society. There are homes in South Dakota and North Dakota that are reliant upon one power line that stretches tens of miles, maybe further, to provide them with what they need to communicate with the outside world, to stay warm during winter bomb cyclones, to possibly power durable medical goods.

There are people who are in some instances quite literally holding onto one line, and that is what's keeping them safe and that is what's keeping them warm and that is what is allowing them to be prepared, should the worst happen. We're aware of this in Region 8. It's something we take very seriously, and it's also something that we understand cascading effects can add up very quickly. We're also looking at a growing sense that intersectionality needs to be the way that we look at preparedness from now on. It can't just be, do you have a go-kit? Do you have a savings account? Do you have homeowners insurance?

There are things that we have to begin looking at now that include aspects such as, where is your nearest licensed medical provider? How far do you have to go? What are the choke points in your logistics to get to your nearest pharmacy? What happens in a given area whenever we see an overall loss of population? That means a simultaneous loss of revenue for public services in an area because people drive the economy. The economy is, first and foremost, the activities of people, and without that, what happens when we see fruit whither on the vine when it comes to your local and sometimes state-level offices that provide care to these areas?

Some people derogatorily call it flyover country. I refer to everything between the Sierra Nevada and the Appalachians as facing this intersectional growing concern. It's a little different everywhere, and I think that the Resilience Analysis Planning Tool can help with some of that. If you go to fema.gov/rapt, R-A-P-T, because I love that play on word, we're playing rapt attention, correct? You'll find two things. One is the toolset, which is an open-access GIS dashboard that pulls in data from the American Community Surveys, census, and some other sources.

For those who are really into data hygiene like myself, there are tables, there's attribution, and there is a change log that's regularly published, so you can see the veracity of the data. But there's one thing I love about this and I feel safe saying this, because the team who's worked on this is fantastic, they're good friends of mine and they're very driven to make everything they do accessible, you will see the tool and the resource center. This is one of the few tools I think I've seen FEMA put out in recent history, where there is a plethora of YouTube videos giving you step-by-step walkthroughs.

How do I understand what is going on in this particular neighborhood? How do I understand what services are being provided in this census tract? Things such as that. I have found it incredibly helpful. We've used it a lot in Region 8. I saw, I believe, someone from South Dakota in here. We used this tool a lot in FEMA Region 8 when we were doing our vaccine rollout, where I served as the chief of staff on the vaccine mission from Denver. Of course, as soon as I started sharing screen, it wants to lag. Isn't that just lovely? You'll see up here you can find different attributes that you can pull and you can sort it on different levels, state level, county level.

I don't think anybody cares about British Columbia. So, I'm not really quite sure why we are there. But one of the things that we found really interesting in this is its ability to pull together social numbers, economic numbers, and data sets that can hint around a growing problem. For instance, you can map income inequality over time using the Gini Index. You can find critical care, and some of this is interesting to me because one of the things I've become more and more interested in as we go along are things like, for instance, are there still a number of churches here or have they started to close over time?

Two books that have really stood out to me in the last couple of years understanding preparedness and our capability to do so were the books, Bowling Alone and Deaths of Despair, which explored the growing sense of loneliness in most of America and how it's significantly impacting our ability to work as a society. As you can see here, you click on this and it pulls up what is called our Community Resilience Challenge Index, which is if social vulnerability is understanding the dynamics of a community, community resilience challenge indicators are understanding that aspect of the community in relation to the capability of the public sector in that area to provide services.

There's a lot of stuff about, how far is the nearest school? How many hospitals are there? How many caregiving licensed practitioners are there per 10,000 people? Median income? Some of these down here, as I said, are very interesting to me, the number of people who profess no religious affiliation. Not that it's a value statement on faith so much as it is a bellwether for social cohesion and that social safety net that exists outside of government service. The same thing for civic and social organizations.

I believe that in the years to come, these are going to take more and more of an important thing as we better understand loneliness and how loneliness impacts preparedness and our ability to respond and recover, especially as climate change really starts hitting parts of the country that are already under-resourced and under-provided for in care, whether that be market dynamics or a lack of equitable distribution of funding from government, or for instance, I'm one of these people who's constantly yelling at the beltway, "Please understand that it is a hard life out here. You do not understand how hard scrabble and sometimes meager this part of the world can be and how unrelenting nature itself is in the Northern Great Plains and the Mountain West."

I do want to close by saying there are tools out there that can help you. Another one you can look at, institution, is Headwaters Economics with their Rural Capacity Index. They particularly focus on understanding rural preparedness, rural resilience, and rural mitigation. They're just some of the most lovely people you can ever work with as well, just on a personal level. It's always a good day when I get to have a phone call with them, but just know, if I haven't stressed it enough, this challenge of rural preparedness, rural mitigation, understanding how climate change is going to begin impacting these parts of the country that are not a large city that receive so much media attention.

You have people who are there. You have people there who want to help. You have people who are passionate about this, and we have people who see the good work, the fantastic work you do and the struggle you go through. Most importantly, I just want everyone here to know you are not alone. You are seen, you are heard, and you are supported. I honestly think that's probably the most important thing I can do on this, aside from dropping a GIS dashboard.

Jeff Hoogheem: Well, it may be morning in still some places. Good morning or afternoon, whichever is right, to everyone. Thanks for inviting me to be part of this panel today. My name is Jeff Hoogheem. I'm the Director for the Center for Health Emergency Preparedness Response at the Texas Department of State Health Services. That's the Texas State Health Department. Today, I'm going to talk a bit about the role of the state in providing resources and specifically supporting rural jurisdictions and specifically, I want to talk from the perspective of the state health department. I'm going to talk a little bit about the state of Texas in general, just to tell you a little bit about the geography and things that occur here in our state and what it looks like here. I know many of y'all will relate to what I'm going to say there.

I'll talk about the role of the state and the state health department in general, in supporting public health and medical response and the resources we might provide. We've had some recent examples of disasters unfortunately here in our state, as you all have probably as well. I'll show you some examples of those and the resources that we've provided during those disasters. We'll talk a bit about resource requests, not specifically how to do it, because I think it's going to be different everywhere, but some tips and some advice I would give you when asking for resources to assist in your area or your jurisdiction. Lastly, we'll talk about the importance of partnerships and how they can really assist you during disasters.

Texas by the numbers, it's a fairly large state, 254 counties, 177 of those are rural counties. We have 1,216 cities and we have six of the most populated cities in the United States, including Houston, San Antonio, Dallas, Austin, Fort Worth, and El Paso. 267,000 square miles, again, a very large state. We have at least one major disaster declared in every calendar year. Unfortunately, in recent years, it's many more than that. As you all have probably seen, the more declared disasters in your states and your areas, we are seeing that as well. Our disasters include tornadoes, floods, wildfires, drought, disease, as in COVID-19 or H1N1.

Regular coastal hurricanes visit the Gulf of Mexico and our state. Often, we have these many different disasters at the same time. It's not uncommon to see a hurricane affecting the Texas coast while we have wildfires and potentially tornadoes and flooding in another part of the state. It tends to be busy here as far as disaster response goes, as evidenced by the fact that we've had 368 major disasters since 1953. But that number is climbing, because that number is only accurate through 2022, and we have a large international border of 1,254 miles.

What are the roles of the state and disaster response in supporting rural jurisdictions? Well, first, I think here at the state health department, we provide technical assistance and guidance. In our program, we're responsible for preparedness and response planning. We do that support throughout the state, but as the state health department, we provide technical assistance in many different ways for public health and medical across the state. Where you are, maybe there are local health departments that are part of the state health department. In some places, those local health departments are not part of the state health department. That's the case here in Texas.

We support not only our local health departments and those jurisdictions, but we provide that assistance to jurisdictions without local health departments, where our public health regions fill that role. We maintain contingency capabilities. What I mean by that is we have contracts and other contingency plans to bring in capabilities and resources to support parts of the state when there are disasters. I'll talk a little bit about that later. We coordinate the overall emergency support function eight or public health and medical response across the state.

Because it's a large state and we have large geographical regions, we play a key role in information sharing, sharing situational awareness and common operating picture. Again, important to this presentation, we provide resources when those needs exceed the local capacity and capability. So, when there's a disaster and the resources that are required to respond are above that which the jurisdiction can provide and/or has, we will help provide those resources if they fall under emergency support function eight. We submit requests through our federal partners to request resources if needed.

As is very important to all of y'all, cost documentation reimbursement is key to something that we do during and also following disasters. Again, tying to the federal resources, when there are declarations, whether they're local or state, we work with the jurisdictions or here at the state level to bring in resources and track those and ultimately demobilize those when they're no longer needed in that area. Our responses as of late, in reverse order, on June 21st this year, we had a tornado in Matador, Texas. Matador is a small town with a population of around 571 people. It's northeast of Lubbock in the Texas panhandle.

A large supercell storm had formed and spawned five different tornadoes that day. One of those storms was a third of the mile wide and went through the town of Matador at 8:00 PM central daylight time. So, just before dark. Peak winds were up to 165 miles an hour. Major devastation and destruction, and there were resources and support that we provided and I'll talk a little bit about that in a minute. Prior to that, about six days earlier in Perryton, Texas, which is on the Texas border with the Oklahoma panhandle, a town of 8,289 people, a small hospital there, a long-term care facility there, a thunderstorm developed and an EF3 tornado went through the western part of the town.

Thankfully, the 25 bed hospital was not hit and that long-term care facility, other than being out of power, was not damaged either. But still significant damage, and we'll talk a little bit about the support there. We had historic flooding in the Texas panhandle, which has seen a lot of drought. Although the rain is welcomed, there's been a lot of flooding. Around the earlier part of June, June 8th or so, we did some response to flooding there. We'll talk a bit about what that looked like. We have had, as many of y'all have had over recent years, a lot of wildfire outbreaks statewide. It's been a bad year. Here in Texas today, it's going to be 105. Our relative humidity is dropping and we expect wildfire support to increase and then that response to continue, at least until we see more rain across the state.

Lastly, none of y'all are unfamiliar with the COVID-19 response and I'll talk a little bit about what that looked like. We've had a lot of disasters here in Texas recently, and so what does the support look like when we have those occur? We'll talk about that. These are the resources in no particular order that we have provided in response to these numerous disasters and disasters just like it. In Texas, we have emergency medical task forces that we organize under the state and they provide ambulances, ambulance strike teams, and ambulance buses. That picture is an Ambus that's a fully licensed 20 or so bed depending on the acuity of the patient.

Fully licensed ambulance, we're fortunate to have many of those in the state and they're positioned around the state. So, we are often providing those. We provide support via medical personnel and that could be EMTs or paramedics. But also, during the COVID-19 pandemic, we provided a lot of medical staff to hospitals and other facilities to keep them operating throughout the pandemic. We provide medical supplies, mortuary resources including morgue trailers, body bags, cooling equipment and those sorts of things. As many of y'all know, when these disasters occur, those normal systems which don't have a lot of surge capacity are quickly overwhelmed.

One of those things that we've seen unfortunately used time and time again is the support to mortuary services and those resources. Zoonosis support is specific to the state health department. When we have a flooding event, like I mentioned in Amarillo, there will often be a proliferation of floodwater mosquitoes that emerge after that flooding. The rain stops, the floodwaters slow down or stop and the mosquitoes hatch out. The support that we provide is when those large number of mosquitoes are inhibiting recovery operations, meaning, workers can't go outside and fix roofs and put culverts back in and fix roads and repair bridges because mosquitoes are just running them off.

We'll go out and do some work with the local jurisdictions to figure out how bad those mosquitoes are, what's being inhibited or what work can't get done, and potentially provide support in the way of mosquito abatement, whether that's spraying or larvicide or other countermeasures to support that effort. It's often something that is in recovery. It happens in recovery phase of the operation, but if you're there and it's affecting you, you realize it's still a very important part of the operation. Vaccine and supplies, I know everyone saw that through the COVID-19 pandemic. Durable medical equipment such as ventilators and wheelchairs and walkers and other types of DME that we provide through many types of disasters.

Lastly, when there's a large disaster, a lot of times there are folks that need to go to medical shelters. These are people that don't meet hospital admission criteria, but they are of an acuity that exceeds that of a local general population shelter. We'll establish medical shelters and provide a place that those folks can get care, so they don't overwhelm our hospitals with people who don't need to be in a hospital. Those are just examples of things that we do during response and some of those may be applicable where you are in your states and there may be probably others too.

Let's talk a little bit about resource requests. The first advice that I would give is leverage your local and regional resources first, and there's many reasons for that. Your local resources or jurisdictions that are nearby that could provide mutual aid or partnerships and contracts that you have, they're going to be the fastest. I say that coming from a state that's very large. Sometimes, our assistance is coming, but it's not immediate. If you can leverage those local resources first, I would urge you to do that. It's better for your community. It's better for your people. It happens faster and it's more seamless if those contracts and those partnerships can be in place before the disaster occurs.

But in many cases, that's not going to be possible. You're going to need to submit a resource request up to your state, or through maybe your county or your parish, depending on how you're set up, up to your state. That could be done in many different ways, and I'll tell you about how we used to do it. We used to use the Incident Command System form, the ICS213 resource request or the 213RR. We transitioned years ago to a State of Texas assistance request that we call a STAR in a system called WebEOC. Many of y'all may use that, but there's probably other systems out there too, and every state's going to have a different process.

But the key there is follow your established process. Many times during disasters, people start doing things that weren't part of the plan and pretty soon, resource requests that you think have been submitted, if they're outside the system that's established, they may not be submitted and you may be waiting for a resource that's not on the way. So, I can't stress enough, follow the established system for resource requests, whatever that is in your area, your jurisdiction, or your state. Some other tips and suggestions I have is avoid jargon and acronyms. You can make no assumption that the person on the other end of that request knows your jargon or your acronym. Spell out as clearly and as concisely as you can the help or the assistance that you need.

When I say describe the requirements, in the next bullet, as specifically as you can. I mentioned the vector control mosquito spraying before. Many times, the equipment that is used for that operation requires specific chemicals at a certain mixed ratio and very specific scientific requirements. So, describe as accurately as you can what you're asking for, so that when you get it, it is what you need and what you can use. I also would suggest you to describe the need. A lot of the times, you may think you know the name of the resource you need. This happens a lot with federal teams and we have teams here in Texas that are named.

People think they know the team and what it does, and they'll ask for that team, but sometimes they get the team and it isn't what they expected. The best thing to do is instead of naming the resource, describe it. For example, if you needed a medical assistance team, a team with certain number of providers that can provide critical care to a certain number of people for a certain amount of time over this time period, that would be much more helpful because then we could look at the resources we have and assign a team to provide that assistance, rather than just a name that says, "I might need a DMAT team," as an example. That's a federal team.

That team may or may not be available, may or may not even be what you need. So, having those need-based specifics really helps us fill those resource requests. I talked a lot already about being specific in technical specs. The contact number from the person making the request is super important. That way, the person filling that request in a logistics section can reach out and ask any questions, can confirm the delivery location, can make sure that we get the resource out the door that is being requested. Lastly, be realistic about the quantities you ask for, the arrival dates, how soon you need it and when, how long it will be there.

Some resources, the quantities that we can provide and even obtain might be limited. The arrival date, knowing how far you are away, it may not be immediate. Sometimes, the disaster... If y'all remember, we had Hurricane Harvey years ago here in Texas, a very large disaster. Some of those resources had to be released to respond to other parts of the disaster. How long do you really need them versus how long you might want them, those are things that I would suggest that you be realistic and know that all resources are in short supply during disasters.

Lastly, I'm going to talk a bit about partnerships. I'm sure, being rural jurisdictions, you understand the value of partnerships. They're key. In emergency support function eight, which is what we do in the health department, we are responsible for a lot of different components of the response, but we don't have all the resources to do those things and we leverage partnerships and contracts to make sure that we can do all of the operations that we're expected to do. So, maintain those relationships, establish them early. You've heard the saying, "You don't want to be exchanging business cards on the time or the day of the disaster." That's true.

I often tell my team, relationships are so key that we have a system, a machine, if you will, that does response for us and it runs. There's laws and rules and established agreements out there in place that make the whole machine run, but the machine runs better and is lubricated by relationships. So, the better your relationships are, the faster that machine moves, the smoother it moves, and the better it operates to respond to the assistance that we're providing when we have disasters across our state. I'm sure that's true of all states. Get your formal agreements and contracts in place early. I talked a bit about contingency contracts.

We learned in many big disasters going back to 2008 and earlier, that if we had contracts and agreements in place ahead of time, the day of the disaster, we weren't trying to figure that out. We established those ahead of the disaster, and I would encourage you to do that if you can. If you reach out to partners, sometimes, it's hard to think of all the different partners you might need. Every time there's a disaster and there's an unmet need and you establish a relationship or a partnership, capture that and then formalize it as part of your after action process. For us, that includes oxygen delivery services. I mentioned mortuary services before. How are we going to do medical sheltering, and who can help us do that?

Mental health is a largely overlooked component of the disaster, the response, and also in recovery. Vector control, again, I talked a bit about that. It's easy to overlook that piece, because it doesn't really emerge quite literally until after the disaster response is over and you moved into recovery. Durable medical equipment for sheltering operations can be hard to find and if you have those relationships before the disaster, it makes it a lot easier to get that equipment. Lastly, don't overlook the value of those volunteer organizations. They're out there, they're eager to help, they're willing to help, and they're very capable. I think identifying those and engaging them ahead of the disaster is very important.

With that, I will wrap up and we'll go on to the next speaker, and I look forward to hearing your questions and answering those when we get to that part of the discussion. Thank you very much.

Grant Brown: Well, good afternoon, everybody. My name is Grant Brown. It's interesting looking at a local perspective of this Rural Health Hub, first from FEMA, the federal level, and then Jeff with Texas, and now our small city, boots-on-the-ground in little Gulf Shores, Alabama. Being in a rural community, Gulf Shores is a double rural community. We have a population about 16,000 people, and we have a significant population of tourists. So, we are a morph between a small city and a large community.

Where is Gulf Shores, Alabama? A lot of people don't even know that Alabama has a beach. We're a beach community right on the shores of the Gulf of Mexico. Pretty picture of the Gulf of Mexico at our main public beach area. We've experienced a significant population growth over the last at least 10 or 12 years. In 2010, our population was rated 9,000 residents and in the 2021 census, we now have a population of 15,700. So, we've grown about 61% since 2010. We're actually by percentage the fastest growing city in the state of Alabama.

With those now, in end of 2022, almost 18,000 full-time residents, we actually have 8 million visitors travel to our small little beach town annually, and that injects about $7 billion in spending and about 63,000 travel related jobs in our county. We have a large county, Baldwin County, which is about the size of the state of New Jersey. Our city's operating budget, for a small city, and I chuckle a little bit, is right at $64 million annually. We're a coastal community that values natural resources, nature, and making sure that we protect our environment and making sure that any action and movements that we take protect this natural environment.

I guess, the perspective for today's topic from me being the public information officer and as my day-to-day job being a recreation director, which is doing fun things within our city and for our residents and for our tourists, but when we get into this mode of disaster recovery and actually preparing in advance of disaster recovery, all of our employees within our city have a secondary job, if you will, within our emergency operations. Planning, documents, each of us have a different role that we would play. Employees that I actually manage on a day-to-day basis may actually report to a different department head or a different department, based upon what's happening within the disaster.

I wanted to talk a little bit about our most recent disaster, which was Hurricane Sally, September 16th of 2020, which 2020, as everybody remembers, was also the pandemic year. Not only were we dealing with a disaster coming ashore as a hurricane, we were also dealing with the pandemic situation, with people in hospital, hospital beds full, the social distancing requirements, and trying to figure out how to navigate through when we had our planning and pre-meetings, worrying about keeping everybody safe in the response as well as actually the response itself.

What's interesting with Hurricane Sally, Hurricane Ivan, which occurred in Gulf Shores in 2004, it landed on the exact same day. September 16th, 2004 was Hurricane Ivan, and September 16th, 2020 was Hurricane Sally. When I go out and speak and talk to different civic groups, we speak about locals, meaning, people who live here and when people moved here, in terms of disasters. Back in 1979 was Hurricane Frederic. That was really the birth of Gulf Shores as a recreational tourist destination, a conversion of small, sleepy beach town cabins on the Gulf of Mexico into more of the condominium and high-rise development.

After a period of time, Hurricane Ivan comes through in 2004, and so were you a resident of Gulf Shores before or after Hurricane Ivan in 2004. Fast-forward to 2010, we went through the Deepwater Horizon and the BP oil spill, another disaster in the timeline, and then of course, Hurricane Sally in 2020. As we look ahead in disaster preparedness and how we, as a small city, have to deal with this on an annual basis, it really boils down to an awful lot of planning and preparation. Oh, I've put a couple of slides. If you just go through these slides, these are just representative damages of our city.

Floodwaters, these were rising water from rain, not from Gulf of Mexico's storm surge inundation. We lost significant levels of sand during this storm. We're actually going through a beach renourishment this Fall, which will add additional sand to our beaches. Our primary dune system, which is on the screen now, did what it's supposed to do. It kept the Gulf of Mexico away from the infrastructure and the damage to our utilities and damage to our private property. We're now having to go back in and replace that sand and put additional sea oats and sand fencing back to rebuild that storm surge protection.

Because Sally was a long-duration storm, we experienced over 30 inches of rain in about a 24-hour period. So, significant rainfall, significant flooding from rain waters, and because of the long duration storm, we also had significant tree loss. In the off-season, being a small rural community, if you will, it's very important, and I heard this when Jeff gave his presentation, to be prepared well in advance, the old adage of prepare for the worst, plan for the best. We want to make sure that we have all of our pre-contracts and arrangements in advance so that if we have a storm, we don't have to very quickly execute contracts and find people who are willing to and able to help us.

Pre-approving contracts with a debris removal contractor, that's the boots-on-the-ground construction company that will preposition their disaster recovery equipment, bulldozers, dump trucks, track hoes, anything that we might need to get our roadways open and to be able to start the recovery effort. We annually do contracts with these contractors to make sure that they're online in the case of an emergency. The next one is emergency management consulting firm. This was a new opportunity for us after Hurricane Sally. We hired a company, Hagerty Consultants was the name of this company, and they were instrumental as we began to document and plan and reply and request FEMA reimbursement for the significant dollars that will be spent during the cleanup effort.

FEMA will reimburse the expense for a consultant. Up to 5% of the total claim value they will actually reimburse as part of their response to a declared disaster or declared emergency. Back to the pre-planning, with debris, you're going to have to find a place to store this, to process it, because as you can imagine, if you wait till the last minute to find a large location to place all this debris, you'll be going backwards. Annually revise a hurricane preparedness plan. We update our list of employees and contact information. We verify that our plan is valid.

We make sure that we have every way necessary to meet our employees, to make sure our employees know when to come back to work and how to reach them, so that we can make sure to start this recovery effort. We do this annually with or without any plan of a storm or any type of disaster. Preparing message templates for various scenarios. I don't know if it's a good thing or bad thing, but unfortunately, we've had a lot of experience with particularly hurricanes, and so we've got a very extensive file of messages that are in a can, ready to be deployed to our public to make sure that they get all the right information that is needed. It gives us a real good opportunity to plan ahead for that.

In Gulf Shores, we experienced 500,000 cubic yards of vegetative debris that had to be brought someplace. This is a picture of our airport, the Gulf Shores International Airport, and you can see the operation. It's moving forward, where the large trucks that are pulling out of the site are working throughout the neighborhoods, clearing the debris off of the roadways. Residents are being told to take all their debris to the curbside. Residents need to make sure to sort their debris, vegetative debris in one pile, white debris, which would be any type of appliances, et cetera, that need to be hauled off and hopefully recycled, and then a third pile of just garbage.

That's pre-positioned messaging that we put out to the community. We also are able to do in this large sorting facility, the white debris goes off to certain recyclers, the large vegetative debris is reduced by shredding. We then take that shredded material and we were actually able to get rid of that material by barge. We're very close to intracoastal waterway, and so companies from South America came up with barges. They actually took all this debris away and used it for their energy needs in their communities.

Even before a storm has hit, one good thing about today's forecasting in today's meteorological science is we now have a number of days in advance of a storm hitting, we have an opportunity to start putting into things in motion even before the public is aware that we, as a city, are putting things into motion. For instance, there will be a time when our city council mayor will actually declare a local state of emergency. One of the other speakers mentioned that. That state of emergency allows the suspension of certain purchasing requirements. It allows for the mayor to execute contracts without going through public hearings.

It's a very much more efficient way to quickly put actions into place if necessary. We activate our emergency operations plan for our city. The mayor is our incident commander, and we have daily briefings as we're watching storms come closer to us. Unfortunately, tornadoes, that's not as well known. You get a little bit of a warning, but it's nowhere near days in advance to plan and prepare. We conduct emergency briefings with essential personnel, but we include our utilities. We include the water company and the sewer company, our power companies, any gas, fiber, technical, cable companies, our tourism officials.

Back to our tourist-based economy, we've got a challenge of getting our 16, 17,000 residents off of our impacted beachfront and off of our island. But before they can leave, we've got potentially 80,000 visitors in this area that need to go up two roadways that go only north. There's only one way in and out of our dead-end destination in the state of Alabama, and that's driving northward. So, they're a big part of how we start messaging and when we start asking them to voluntarily evacuate, if need be. Only the governor of the state of Alabama can issue an evacuation notice.

For a lot of reasons, until that cone of uncertainty zeroes in on our particular area, very hesitant to do so because of the economic impact that that would cause if that storm does turn and go a different direction. We have a large state park. So, we include our state park officials, our chamber of commerce, which helps communicate and coordinate with our different businesses, and of course, our volunteer agencies. I heard Jeff talk about the volunteers. Volunteers can be a double-edged sword. If you've been through any type of a disaster, whether natural or manmade disaster, it's great to have the assistance.

But if the volunteers just start showing up and looking for something to do to help, as good as their intentions are, unfortunately, they tend to get in the way. One of the things that we do and are able to do because of our geography is we'll put a roadblock. There's only one bridge into Gulf Shores, and so we can block that road off. We'll get the state troopers or county sheriffs to put a blockade there, and we can control access and only allow certain entities and businesses, utility companies, to start the initial cleanup and assessments before we allow volunteers to come in and truly get in to help.

All this information is being put out to the public in advance through our social media and different news stations. All year long, we keep good communications open with all of our local media to make sure that when we need them, we can immediately call upon them and they're willing to jump to any type of aid that we need. Of course, we start coordinating our anticipated relief materials with our county, Baldwin County, with our state EMA, and with our federal partners. We do use a single point of contact to request any type of aid. When Jeff mentioned, the detailed request, how important that is.

If you request a tanker, you may end up with a truck full of fuel or you may end up with an airplane. It can be that different, the vernacular that's used within the different areas. So, you've got to be very specific as to what you're requesting and when you're requesting. For us, using EMITs, which is our way, which is Emergency Management Initiation Terminal number, that is how we make sure that if we request a mutual aid or some type of asset to come in, that it gets logged and it gets recorded, and then we will be able to be reimbursed for the expense of that arriving or being used.

Once a disaster occurs, this initial damage assessment is vital. So, we immediately go out into the community with our employees. If it's a significant storm, where we have vacated and evacuated people off the island, we go in, we do a windshield assessment, and that's necessary in order for us to quantify the damage as a state in order to qualify for the FEMA coverage. Again, everything you do, document, document, document. Take a picture of every damaged area, document it. Put more documentation together than you can, make it be somebody's specific duties to do that. We communicate to the public through all our different channels.

One thing that can happen when you have a disaster is there are significant... Not significant, but there are a number of people who will come into your area from other areas and they will try to prey upon the damage and the destruction that's being had. Tree companies, things like that, where you'll get people coming in and they'll start asking you to pay huge amounts of money to remove trees. They don't have business licenses, they don't have insurance documentation. They're just rogue businesses trying to come in and prey upon unsuspecting people. So, we work very hard to make sure that any business that comes back to the island has a credential. They have to have a business license. They have to have a placard. They have to prove that they have insurance. So, we do our best to protect our public and we do that also by communicating this through different channels.

I think as a rural community, as you start planning your budgets, in every opportunity that you have to build reserves, build a bank account, if you will. Reserve money to be able to respond to any type of a disaster. With Hurricane Sally, we had spent $26 million in actual invoices paid out of our city budget, before we received $1 of reimbursement. So, you can imagine if we did not have the reserve capacity or even the bonding capacity or the loan capacity to be able to borrow that money as a short-term loan until we were able to get that money back from FEMA. It's very important that you do this planning and preparation, particularly if you have a small budget and you're not able to cash flow your payroll and cash flow your other operations because you're going to have to pay the bills and it can take a long time to get any reimbursement money.

Some of the lessons learned, never underestimate the disaster, in our case, the storm. With Hurricane Sally, we anticipated a Category 1 storm coming ashore and really hadn't thought it was going to be as significant of a storm as it was. It got to that point, it very quickly intensified, and it changed direction. At that point, it was too late to evacuate. At that point, it was where it would be more dangerous for people to actually leave their homes and try to drive and be on the roads when the storm hit. So, people unfortunately just had to hunker down and make their way through it. With Sally, luckily had no injuries, no deaths. We were very lucky and dodged a bullet we feel.

Another thing is that time is your best friend. If you do have the opportunity to do the pre-planning when the sun is out, when you don't have a disaster beating down your door, or even if there's a disaster approaching, if you are able to. As soon as a storm enters the Gulf of Mexico and we start watching whether it's going to Texas or going to Florida or coming up at us in Alabama, very quickly, we'll start pulling all these documents out and making sure that all of our pre-planned contracts are in place, making sure the debris contract is in place, making sure we have a plan.

When you're actually responding after a disaster, you're going to have fatigue. Particularly, if you're a small staff or if you're a small city, you're going to have to work basically 24/7 for a number of days, and it's going to be days and months and potentially even years. Make sure that you've got a plan for a backup. I have a deputy PIO. He's our economic development coordinator is his day job, but when it comes time for an emergency situation, he and I will tag team the role of public information officer, where if I'm sleeping and trying to take a break, he'll be able to respond and be proactively engaged with our response.

As you go down the days with your recovery, recovery goes on for a long time, but you still then have to get back to the normal day-to-day business within your organization. You still got to provide the services for a general city and potentially even worse as you get the people that come in. The amount of contract work and amount of actually construction that goes on after a storm for many months and years to do the recovery can be just as difficult to manage with your planning and zoning departments and with all the other layers of approvals that have to be gone through before the actual work can be done. So, that can become a challenge.

I guess, to wrap it up, a challenge for a city is that a fine line exists between proper caution, how you prepare, how you define, when you start talking about disasters. You got to be careful of this cry wolf syndrome because if you start talking too much about disasters before the disaster hits, and if they are a near-miss and they go someplace else, then all of a sudden, the next time you've got a disaster, people may not take you as seriously. So, it's a very fine line to how you prepare for and plan and go through the notifications and manage, and then at the end of the day, how you respond to these storms and these disasters.

Appreciate your time very much. Again, I'll also be able to answer questions. You've got my contact information there on the screen, gbrown@gulfshoresal.gov. I'm happy to answer any questions even offline afterward.

Kristine Sande: Question for you, Grant. How often does your rural community perform tabletop and full-scale exercises with your partners?

Grant Brown: That's a great question. We probably don't do it often enough, but we do it every three years roughly, every two and a half or three years. We have not had a tabletop exercise since 2020 with Hurricane Sally. So, we are now primed to do that again. This is not necessarily storm related, but this week, our police department, fire department, and local EMA and others are doing an active shooter tabletop exercise at our school system. We do work to make sure that our training modules are very often dusted off and reiterated, but as we go back to kids going back to school, we're doing that one this week. We've done airport simulations with an airplane crash, where we've had everybody in the room together, our agencies. We're very close to a city next to us called Orange Beach, and they share this airport, and so we have mutual aid agreements with Orange Beach and with Gulf Shores. I don't think you can do them too often. It's a big commitment to do them and to do them right. So, we're about every two or three years.

Kristine Sande: There's a question about transportation and whether transportation services should be included in the list of folks that a rural community might want to partner with. Any thoughts on that? The importance of transportation in an emergency situation? Jeff, do you want to start?

Jeff Hoogheem: Sure, yeah. I'm sure others have something to say on this too. I didn't intend the list that I gave, if that was about the list I gave, to be all-encompassing or exhaustive. There is no question that transportation resources, and Grant was just talking about hurricanes. When we do coastal evacuations, transportation is critical. That's not just buses and general population transportation, but medical also, and that could be ground and air ambulances and Ambuses that I showed. Again, not the kind of thing you want to try to figure out the day of the disaster.

I'll say it this way, a lot of facilities in the health and medical realm have transportation contracts and they work wonderfully when they're the only facility evacuating or moving. But when every hospital or every long-term care or every nursing home is moving at the same time, those contracts come up short. If you're a jurisdiction and you can have a transportation contract or relationships that you established ahead of time before the disaster and have that in place, unfortunately, you're probably going to need it because the transportation becomes a critically short resource in those circumstances.

Grant Brown: This is Grant from Gulf Shores. Our Baldwin Rural Transit Authority, which is our BRATS bus, we have a list. Our fire department maintains a list of all the different memory care facilities and senior living centers that are suspect to needing to be evacuated during certain types of hurricanes. Again, I keep talking about hurricanes as disasters because that's what we're most familiar with. In this case, if it's a strong Category 3 coming, we know immediately that those will be evacuated because at the point of people staying, it's much more potentially harmful for them to stay than to go.

The difficult ones are the storms that we're not exactly sure, that whole idea of the quick intensification and the opportunities for these storms to very quickly gain strength. You don't have time if you wait, and so that's probably the hardest decision we have is when do we start working with the senior living areas, the memory care facilities. Our hospital is actually about six miles inland. I don't believe it's ever evacuated, but it's definitely something to be part of your planning and particularly tabletop exercise from that last question.

Daniel Green: Yeah, I think I agree. I don't just think, I know I agree with everything that Jeff and Grant just said. It's absolutely one of those ounce of prevention is worth a pound of cure. But I'll also say that one of the things to keep in mind is also transportation needs through the response and recovery after a disaster as well. Texas is probably the state that I have more in common with than Gulf Shores. No offense to Gulf Shores, we just don't have a lot of hurricanes in Colorado, Wyoming, and if we do, I think we have bigger things to worry about.

But one of the things we constantly run into, especially with flooding events or for instance, some of these freak major hailstorm events that happen in the Great Plains sometimes, is people who had a car and lose a car and then need to somehow work through a car-dependent culture to get to the place that allows them to receive programmatic assistance afterwards. In the states that I work in, we have some counties that are as big as states on the East Coast. Trying to figure out how to move people through sparsely populated, far-flung areas to get to a single point where they can just sit down and talk with someone is another major consideration.

So, I'd say that thinking of transportation, both in terms of preparedness, in terms of evacuation, in terms of moving your at-risk communities, limited mobility, durable medical goods, chronic medical conditions, so on and so forth. There also needs to be probably thinking of it in terms of a life cycle, which also includes use of transportation to move people to essential government services afterwards. If somebody had a car and they had no problem driving to dialysis before, how are they going to have access to dialysis if three feet of roaring water destroys their car?

If they do need to register for FEMA programmatic assistance or small business administration assistance or state assistance, how are they going to get to the disaster recovery center so they can do that? So, transportation is a constant, kind of like power throughout the entirety of a disaster. It has to be there, or else everything becomes a house of cards.

Kristine Sande: What mile radius is recommended for partnership resources, especially in thinking of evacuation procedures for coastal communities? Is establishing partnerships more difficult if recipients of services must cross state lines?

Jeff Hoogheem: This is Jeff. I think I can start. I would be hesitant to give you an exact mile radius, but I would think about those partnerships and those jurisdictions that would or would not be similarly impacted as you. If you're going to reach laterally, it's to Grant again, in this scenario with the hurricane, you'd want to have a partnership and to be thinking of a jurisdiction that may not be impacted by the same storm, if that's something that you're thinking about, because they're just going to need their resources and you're going to be counting on something that may not be coming.

It is more difficult over state lines, though not impossible. We've good relationships with our partners in Louisiana and we do in fact support each other across that state line. So, I don't think those are insurmountable tasks across state lines. There just is a couple more things you need to think about with regards to doing that, but it can be done. While I'm talking, Kristine, I will say the other suggestion, I think access and functional needs and disabilities is probably an entire session that could be talked about. It's near and dear to my heart, and it's more than just a piece of what we're talking about today. It's an entire thing we need to address.

Kristine Sande: Thank you so much to our speakers today for their presentation and sharing their expertise with us. The slides used in today's webinar are currently available at www.ruralhealthinfo.org/webinars. In addition, a recording and transcript of the webinar will be made available on the RHIhub website.