Many of the economic, housing, physical and behavioral health, and social services provided to affected populations during response and early recovery following a chemical incident (discussed in KPF 5, Augment Provision of Mass Care and Human Services to Affected Population) may need to be continued for the long term. The provision of survivor services after assistance centers have closed will involve agencies and organizations that did not play a major role in the initial response, such as state and local mental health agencies and long-term housing authorities, as well as the continued support of voluntary and private organizations. Planning will be needed to ensure all needed services transition from the reception/assistance center hubs to providers of long-term survivor/family services.
Mechanisms for continuing emotional and social support at the community level should also be considered, as everyone who participated in the response will be affected by the incident – survivors, their loved ones, law enforcement, EMS, other responders, hospital staff, and the staff of assistance and sheltering centers. For example, London established a “Family Resiliency Center” after their 2005 mass transit bombings, acknowledging that many might need emotional support over a longer period of time. Similar centers were established in Las Vegas, Orlando, and Boston after they suffered mass casualty events. Multiple, coordinated pathways to healing for all involved can help ensure community resilience.
For large-scale or highly toxic chemical releases especially, the affected population may need access to event-related health services for an extended period of time. Recall that survivors of chemical incidents can face special physical, behavioral, and mental health challenges in comparison with other types of disasters. Long-term medical monitoring of exposed and potentially exposed populations and the provision of monitoring and long-term care for those with medical complications and/or chronic effects caused by the chemical may be needed. For example, long-term surveillance for cancer and birth defects among the exposed population may be recommended, depending on the substance released; injured patients may require long treatment regimens with specialized drugs. In addition, strategies, systems, and facilities for the provision of ongoing medical care for the potentially large population of displaced persons, such as those normally residing in long-term care facilities, those undergoing dialysis, and those receiving antiretroviral therapy, among others, must also be arranged. For all types of health challenges, assistance in accessing essential medications – including those for addiction treatment – may be needed when infrastructure systems are impaired.
For efficient and effective attainment of recovery outcomes, the community’s health care system must also address the full range of psychological, emotional, and behavioral health needs associated with the disaster’s impact and resulting recovery challenges. Behavioral health assistance provided in recovery may include provision of information and educational resources, basic psychological support and crisis counseling, assessment, and referral to treatment when needed for more serious mental health or addiction issues.86 Again, ensuring affected populations have reliable access to needed medications throughout recovery is essential. In some chemical release scenarios, especially those resulting in persistent contamination, reoccupation of affected areas may be delayed or prohibited, and populations may need housing assistance for an extended time. As part of their sheltering plans, SLTT authorities should outline a transition from mass sheltering to alternate options, including Transitional Sheltering Assistance (TSA) for eligible applicants if a major disaster declaration is approved, or for a timely termination when sheltering is no longer needed. When housing assistance is still needed as recovery progresses beyond sheltering activities, the provision of such housing assistance is guided by the Housing RSF under the NDRF. Options for rental assistance, repair, loan assistance, replacement, factory-built housing, semi-permanent and permanent construction, referrals, and for the identification and provision of accessible housing should be considered. For incidents in which homes or neighborhoods were contaminated or destroyed, permanent housing solutions may include rapid remediation of homes, construction of new homes, and/or development of communities adjacent to the contaminated area (that can support businesses within the region). The availability of housing solutions has the potential to significantly impact the community’s ability to achieve economic recovery outcomes, as without adequate housing availability, people may not be able to remain in the area, depriving the community of its workforce and local business market.85
Finally, the community’s economy plays a key role in its overall health and resilience. Community-wide attainment of economic recovery outcomes may require long-term efforts to restore and/or maintain an environment in which local businesses can return to operation or continue to operate. Restarting and recruiting businesses back into the impacted region so that life can transition to a “new normal” following a large-scale chemical incident may also require levels of trust, transparency, and stakeholder involvement well beyond those needed following traditional natural disasters. The situation may also be leveraged to create new employment opportunities in the region, as residents could be trained to conduct remediation operations. The pre-incident development of plans enabling state and local governments and business leaders to take prompt, coordinated steps shortly after an incident will reduce the incident’s economic impacts and support the return of business activities and a sustainable and economically viable community.85
Footnotes
85. U.S. Department of Homeland Security. (2016, June). National Disaster Recovery Framework. 2nd ed.