Monday, June 3, 2013

Lessons from Sandy Regarding the Elderly, Heating

The New Jersey Institute for Social Justice prepared an in-depth report on the ways in which special groups of New Jersey residents were permanently hurt by the storm, more than the average resident. The report can be accessed here.

The report found that (1) Sandy deaths in New Jersey were concentrated among elderly people and (2) many of these deaths might have been prevented if the victims had been better informed about using generators and ovens for heating.

This post reviews the information. Relative to population, the incidence of deaths was greatest in New Jersey. As of November 17, 2012, Hurricane Sandy was blamed for the loss of 106 lives in the tri-state area – 64 in New York State (mostly in Queens and Staten Island), 37 in New Jersey, and five in Connecticut (http://nyti.ms/WlzwsI).

Most of Hurricane Sandy’s fatalities in New Jersey have been among the elderly: 21 of the victims, or 57 percent of those who died, were 65 or older; and 31, or 84 percent, were 50 or older. The numbers are similar for New York. (See Chart 1.) 

Chart 1. Hurricane Sandy Deaths, by Age, NJ and NY
Note: The total U.S. death count was 132 as of January 7, 2013, according to the New York Times, Jan. 7, 2013. Source: Chart computed by NJISJ from database posted by the New York Times, November 18, 2012.

Hurricane Sandy has exposed shortcomings in health care, especially for the elderly. The list of causes of death of the elderly shows repeated instances of preventable fatalities.

Some people killed by Hurricane Sandy were drowned by rising water or hit by a falling tree. These accidents could happen to anyone, although people who have restricted mobility are particularly vulnerable to them. The major remediable cause of death in New Jersey was asphyxiation, which includes carbon monoxide poisoning.  (See Chart 2.)

Chart 2. Hurricane Sandy Deaths by Cause, NJ & NYS
Note: “Was hit” generally means by a skidding vehicle on a street. “Asphyxiation” includes carbon monoxide inhalation from heating via a stove or running a generator in a closed space; such deaths are called “indirect” by the National Hurricane Center. “Tree/debris” as cause of death usually means a branch or tree falling of its own weight, or debris propelled by wind. Such deaths are described as “direct” consequences of the storm. Source: Chart computed by NJISJ based on database posted by The New York Times November 17, 2012 (http://nyti.ms/WlzwsI).

Asphyxiation is typically caused by residents’ attempts to alleviate the cold during a power outage.  Some may light a fire in the home that gets of control or sucks out the oxygen, while others run stoves or generators inside or near a living space, which can lead to carbon monoxide poisoning. Some in New Jersey also died of the cold itself – that is, of hypothermia due to loss of heat and lack warm clothing or blankets. The rate of asphyxiation and hypothermia continued to be much higher than normal for some weeks after Hurricane Sandy, as a cold spell hit and many displaced people lived in unheated conditions, leading to reliance on stove heat.

Another common problem during and after Hurricane Sandy hit was lack of backup power for medical equipment such as respirators. Special trips to replace run-down batteries on medical equipment were priced as high as $200. Service delayed for some meant service denied, and in some cases it meant death. Elderly people who were isolated and could not help themselves perished for lack of family, friends or a service to check on them.

The Dangers of Physical and Social Isolation

During the Chicago heat wave of 1995, the neighborhood of Englewood had 11 times as the neighborhood of Auburn Graham. The difference can be attributed to the strength of contacts among members of these communities (Eric Klinenberg in “Adaptation”, The New Yorker, January 7, 2013, p. 32, http://nyr.kr/111DjP7). People in Auburn Gresham communicate, and life expectancy is high. Compared with Englewood, says Harvard sociologist Robert J. Sampson, communication in Auburn Gresham is as effective in preventing heat-related deaths as having a working air conditioner in every room.

Communication among neighbors and centers of community activities is important for two reasons:
  • It amplifies the transmission of useful information around the community, ensuring for example than no one is unaware of the risks of using a generator or how to mitigate those risks.
  • It allows Good Samaritans to check to see who nearby needs help.

Main Conclusion

Most of the New Jersey residents who died as a result of the storm were 65 or older. The leading causes of death among this age group were asphyxiation, as respirators could not work without electricity, and carbon monoxide poisoning from fires or generators.

Some of these deaths might have been prevented by means of greater communication among and with vulnerable groups. A plan for achieving this goal should be developed before the next storm season.

Recommendations to Agency Planners: Prepare for the Next Storm with the Elderly in Mind
  • Organize  buddy systems for the elderly, pairing those with phones with those who do not have them. Encouraging able-bodied and socially connected neighbors to keep tabs on the elderly in their community who would otherwise lack social support in a crisis. The cost of such a program would be minimal if volunteers could be recruited from churches, senior centers and other socially involved community meeting places.
  • Special efforts should be made in a storm to identify and communicate storm warnings and advice to elderly or disabled people.
  • An educational campaign is needed to explain the shortcomings of ovens and generators as heating sources in a blackout. Public utilities could be enlisted to circulate information on avoiding death from this cause.                      
  • When medical equipment is installed in the homes of elderly people, the length of time that backup batteries work should be communicated to the families and professionals who look after the elderly in case of a disaster, and a follow-up system needs to be in place. Governments’ and utilities’ storm warnings should alert people to check and recharge batteries. Similarly, the medical profession and pharmacies should alert patients to the need to have several weeks’ worth of life-sustaining prescriptions available in an emergency because it may not be possible in a blackout to dispense prescriptions.
PSE&G is prepared to assist families reliant on medical equipment if they pre-register with PSE&G to receive priority attention in the event of an outage. To request the service, call 1-800-436-7734.                 

Recommendations to Households: Make Sure All Adults Know How to Operate a Home Generator Safely

Home generators are handy for backup electricity in case of a power outage, but must only be used in accordance with the manufacturer's guidelines.
  • A back-up generator may only be connected to your home's electrical system through an approved transfer panel and switch that has been installed by a qualified electrician. Never connect the generator to your home's main wiring circuit.
  • Never plug a generator into a wall outlet, as serious injury can result when the current produced by the home generator is fed back into the electrical lines, and transformed to a higher voltage. Disconnect your home from the power system before hooking up a generator. Feeding electricity back to the grid can endanger the lives of utility employees working to restore power.
  • Plug lights and appliances directly into the generator. Use extension cords if necessary, but do not exceed the recommended wattage noted on the generator and use properly rated, UL or CSA-approved  cords.
  • To operate a generator safely, follow the manufacturer's instructions and operate the generator outdoors in well-ventilated conditions, well away from doors or windows, to prevent exhaust gases from entering the house. Gasoline powered generators can produce carbon monoxide, which can be deadly.