On the night of May 28, 2012, more than 100 mm of rain flooded the secondary sewage treatment plant in Thunder Bay, Ontario. Our city was in a state of disaster. Volunteer efforts to provide support to areas of Thunder Bay that were impacted commenced by a local community church.  NorWest Community Health Centres (NWCHCs) offered to provide mobile health services to assist vulnerable  individuals and families and a health care collaborative was formed to engage other health and social service organizations.

A joint operation was coordinated between Red Cross, Community Care Access Centre (CCAC), Canadian Mental Health Association (CMHA) Crisis Response Team and NorWest Community Health Centres (NWCHC) to assist with the provision of health and mental health care of individuals impacted by the flood. Additional organizations such as Thunder Bay District Health Unit (TBDHU), Thunder Bay Counselling Centre, GAPPS street workers and Catholic Family Development Centre were also mobilized as community partners. Ongoing engagement and evaluation of needed services took place with community volunteers at the local church to ensure community needs were being met. On site nursing, Nurse Practitioner and counselling services were mobilized.

The mobilization and dispatching of health and mental health services teams was intended to provide immediate services to vulnerable individuals and families within their home environment. Despite the uninhabitable conditions of many of the homes and increasing concern about respiratory illness and skin conditions due to sewage back up and mold, many individuals refused to leave their homes. Individuals expressed concern about looting, having limited access to evacuation sites which accepted pets, and, not wanting to miss insurance adjustors. Many individuals did not understand the health implications of living in such conditions and this became a growing public health concern.

A triaging process was developed whereby Red Cross volunteers completed an initial assessment to identify households, individuals and families that required primary health or mental health care. Approximately 30 to 35% of households fell into this category. As a result of the volume of households being referred by the Red Cross for health and mental health support the triaging process evolved to daily meetings between stakeholder groups. CCAC established a comprehensive template to assist with the daily tracking and monitoring of households referred; households, individuals or families were assigned to each agency as deemed appropriate and mobile health and mental health care teams were dispatched. A daily intake review including case assignment and ongoing case management meeting with front line workers from each agency was held at NorWest Community Health Centres.

New front line staff were provided with up to date information regarding the flood relief process and partnered with staff who had been involved with the flood relief. On a daily basis two or three Mobile Units staffed by Community Health Workers, Registered Nurses and Crisis Response workers from NorWest Community Health Centres were sent out to further assess need of flood affected households and refer to the appropriate care and service provider.

A team which consisted of a Registered Nurse, therapist, and CCAC Case Coordinator was placed on site at the community church. Health care issues beyond the Registered Nurse scope of practice were referred to the NorWest Community Health Centres’ Urgent Care clinic or seen immediately by a NWCHCs Nurse Practitioner to ensure health care was provided to divert visits to the local hospital Emergency Department. Taxi vouchers were used to send clients to NWCHCs or to the Thunder Bay Regional Health Sciences Centre Emergency Department. Resources, flyers and information about flood relief was distributed during this time to provide up to date information as electricity had been turned off in many homes.

This experience provided important insight into the critical tole of Community Health Centres in local disaster relief efforts. Community Health Centres play a valuable and meaningful role within many of our communities. Our ability to quickly adapt and respond in a meaningful way to community issues was evident from our experience in Thunder Bay.

Dialogue within our communities must take place to ensure that Emergency Operations Committees understand the valuable role that Community Health Centres play with regards to knowing and understanding the local community and the population served by the CHC. It is imperative that disaster planning incorporates and attends to the holistic needs of individiuals and families wihthin the community. Community Health Centres need to be active participants in this process.

Other key  lessons learned were:

1. Community Health Centres can and must demonstrate leadership and respond to unmet community needs and potentially challenge existing systems.
2. Effective disaster relief requires the right leaders and the right partners at the table
3. Establishing linkages and clarifying the role of municipalities is necessary
4. immediate disaster response requires active support from funders
5. A standardized electronic disaster screening tool is required to gather the necessary information and attend to issues of privacy
6. Immediate increase of primary and allied health care staffing required during disaster relief
7. Protocols are required for the implementation of Critical Incident Debriefing
8. Protocols are required to address issues of absent landlords, vulnerable individuals refusing to leave their homes due to fear of looting, placement of pets, hoarding and capacity concerns.

See our poster presentation from the 2013 CACHC Conference, in Saskatoon.

Juanita Lawson is Chief Executive Officer with NorWest Community Health Centres, headquartered in Thunder Bay, Ontario.