As Hurricane Ian Makes Landfall, Florida Health Centers Stand Ready - Direct Relief

Hurricane Ian neared Category 5 strength earlier today, with winds of over 100 miles per hour off the western coast of Florida.

Several Federally Qualified Health Centers (FQHCs), which provide primary preventative care to everyone regardless of their ability to pay, sit in Ian's projected path. Over 1 million patients are currently in Ian's path. For many people, FQHCs are their only source of healthcare, except for emergency departments – which is also the case during and after natural disasters.

"In many communities, after a hurricane, the local private sector won't be ready to open their doors. FQHCs have a mission to meet their community needs immediately. They need to be open right away if people need a place to go… for the uninsured and elderly, it's the only place to go, except for the ER, which is the worst place to go," said Andrew Behrman, president & CEO of the Florida Association of Community Health Centers, which counts 54 FQHCs among its members.

Behrman, who has more than 20 years of experience in his role, said the combination of high costs, long wait times, and diversion of limited resources makes a post-hurricane ER a suboptimal choice for non-emergency care.  

Ahead of the storm, Behrman said Florida FQHCs are currently focused on ensuring staff and patients are safe from harm's way. He said most will be closed today and likely tomorrow, primarily due to patients being evacuated.

"We've encouraged those in the evacuation area to get the heck out of there," Behrman said, adding that clinics have used "every tool they can," including emails, text messages, Facebook, and personal phone calls to inform patients to evacuate. "I have lived in Florida for over 60 years, and the last thing you want to do is be in the path of Cat 4 or 5 storms," he said.

FQHCs in Florida have also been testing generators and are coordinating details to stay in contact with local and the State Emergency Operations Center as well as with Behrman's organization – one of the most critical aspects of disaster response and recovery, Behrman said. To ensure ongoing communications, FHQCs in the hurricane's path have been given satellite phones. Plans are also in place to deploy "MASH-style" tents so that people can still be treated even if a building has been rendered operational, along with generators and wash stations shortly after the storm passes. These purchases were made possible by a Direct Relief grant.

Though not set up for emergency care, FQHCs are also prepared to stabilize patients experiencing acute trauma before getting the patient to an appropriate facility, Behrman said, again noting that communication, in this case with a local acute care center, was vital.

Offering continuity of care, especially for chronic conditions, has proven crucial in the aftermath of hurricanes.

A multi-decade study published in JAMA showed a 33.4% higher death rate after major hurricanes in the United States. The increased death rates were seen in causes of death such as injuries, infectious and parasitic diseases, respiratory diseases, cardiovascular diseases, and neuropsychiatric diseases. No increases were seen in cancer-attributed deaths.

During disasters and daily life, certain groups are more vulnerable to adverse health outcomes. Age, income, and having a disability, along with other social determinants of health, are correlated with worse health outcomes, which can be magnified during natural disasters when disruptions to care are more likely to occur—making it more difficult to obtain medications and power medical devices.

 Of the 1.05 million Federally Qualified Health Center patients in the hurricane's path, according to a Direct Relief analysis of U.S. Health Resources and Services Administration data, about 11% are under six years old, 50% live at the federal poverty level or below, 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 older than 65 years old, which is 8.5% higher than the U.S. national average of 16.5%. Hillsborough County's population is younger than the average, but 14% of the population lives below the poverty line, compared to the national average of 11%.

Across both counties, which are the two largest counties by population on the Gulf Coast in Hurricane Ian's projected path, there are about18,000 people with power-dependent medical devices. The national average per county is 895 people. A 2010 study showed the average backup battery for an intensive care ventilator lasted between about  20 and 170 minutes.

Earlier this summer, in line with a program established in 2007, which began in the wake of Hurricane Katrina to help support FQHCs, Direct Relief prepositioned a dozen Hurricane Prep Packs in Florida. The packs, which contain over 210 different products, and have been refined and updated based on feedback from FQHCs and other medical providers, currently have a range of antibiotics, syringes, basic first aid supplies, and medications to treat conditions such as diabetes, hypertension, and severe allergic reactions. One of the recipients this year was the Tampa Family Health Center, one of Florida's largest Federally Qualified Health Centers.

Behrman said that as the storm approaches and the mission shifts from evacuation to reopening, his organization and the FQHCs they support would remain focused on the stakes involved.

"At the end of the day, we may be the only option for people," he said.