Emergency antibiotics. A family meeting spot. Weatherproof renovations. For local healthcare organizations, the lessons learned from a natural disaster are hard-won and carefully implemented.

Hurricanes, extreme temperatures, wildfires, tornadoes, and earthquakes each pose catastrophic threats. As these disasters worsen and occur more frequently, local responders are learning how to prepare their neighbors and safeguard community health.

Each year, Direct Relief stages caches of emergency medicine in locations across the United States that are vulnerable to hurricanes, and gathers information and wisdom from health facilities that opened these hurricane prep packs during or after the tropical storm season.

With the 2024 hurricane season underway, Direct Relief spoke to two past and current recipients of the packs, the Mobile County Health Department and Virginia B. Andes Volunteer Community Clinic to discover what they’ve learned from responding to disasters.

“Make sure you have a plan for your people, make sure you have a meet-up place, and make sure you have enough medicine to last you,” said Melissa Creighton, grants manager at the Mobile County Health Department in Alabama.

Mobile County experienced extreme winds and flooding from Hurricane Michael in 2018. Originally, the National Weather Service predicted that it would be a milder event by the time it hit the Florida panhandle. Conditions changed rapidly, and by the time it made landfall, Michael was a multi-state Category 5 tropical storm with winds over 160 miles per hour.

Over two dozen people died and many more were injured.

Since the brutal disaster, Creighton says the Health Department has made changes to better prepare for future extreme weather events. Staff members use social media and a real-time phone application to update residents on potential storms. An update might tell residents what items to keep on hand, whether an evacuation is needed, and where to go for assistance. They’ve set up a robust emergency response plan for staff to coordinate communication and expectations throughout an event. Storm watches start as early as 120 hours before projected landfall.

The department has also installed new generators at healthcare facilities and refurbished an old school building to use as an emergency medical shelter. The shelter’s reliable power source has become crucial for residents who need to shelter in a temperature-controlled environment or need to power a medical device.

Another innovation is stockpiling emergency supplies of insulin, antibiotics, and bandages for anyone who’s had to leave home without their supplies.

“We’re really a last resort for folks,” said Kelly Warren, executive director of Family Health at the Mobile County Health Department.

In Florida, Suzanne Roberts, CEO of the Virginia B. Andes Volunteer Community Clinic, said they will use a mobile medical unit for better access to rural and hard-to-reach residents during difficult weather.

Florida was heavily battered in 2022 as Hurricane Ian, a Category 4 storm, landed in the southwestern part of the state, then traveled up the coast as far as North Carolina. In Port Charlotte, where Virginia B. Andes is located, roofs were torn off houses and debris cluttered the area after the high winds and water subsided. Roberts said the storm caused $300,000 of damage to the Virginia B. Andes building, including the roof, two air conditioning units, and the ceiling. Staff at the clinic were able to use medicines from Direct Relief’s hurricane preparedness packs, as well as field medic packs, to treat patients after Hurricane Ian.

With a $100,000 emergency grant from Direct Relief, Roberts said the health center has installed new air conditioning units destroyed after Hurricane Ian to keep residents cool during the excessive heat; restored generators at their free-standing clinics; stockpiled emergency response kits in their pharmacy; and weatherized their building to prevent further roof damage. Additional funding for repairs was secured through insurance, FEMA, the National Association of Free and Charitable Clinics, and other nonprofit organizations.

“I think we’ve got it pretty buttoned up in regards to how we’ll make a difference this year versus our last hurricane,” Roberts said.

The local county commission approved a $750,000 grant to the health center to support a new mobile health unit, Roberts said. In exchange, health center staff will serve the surrounding counties, traveling to people who don’t have reliable transportation, live in rural areas, or have difficulty leaving their homes. New partnerships will help with the increased staffing these measures require.

Roberts said that since Hurricane Ian, staff have learned how important it is to communicate with staff and local partners on extreme weather response. For example, when Ian hit Charlotte County, the hospital experienced major damage, and relied on the health center and other providers to serve patients. Now, health services throughout the county will work together for the upcoming hurricane season.

These preparations are important for another reason: Recovering from a disaster can be slow and unpredictable.

Natalie Simpson, a faculty expert on emergency management at the University of Buffalo, told Direct Relief in November that federal dollars for emergency response aren’t allocated until local officials declare a state of emergency. Even then, filing documentation and waiting for reimbursement can take months or even a year.

Direct Relief contacted the Federal Emergency Management Agency in November, requesting information on the money spent to reimburse hard-hit areas from natural disasters in the last three years. The agency declined to provide specifics, as some emergency declarations are still in place. One thing was clear, however: Public need for these funds has only gone up.

“The cost and frequency of national disaster declarations has increased markedly over previous decades. Regardless of the number of disasters or their intensity, FEMA is ready to help communities before, during and after disasters,” a FEMA spokesperson wrote in an email to Direct Relief. “And FEMA is not in this fight alone. FEMA works closely with our federal, state, tribal, territorial, and local partners to reach the communities who need assistance the most.”

Most recently, CARES Act dollars were used to support emergency response needs, health centers reported.

“We were very excited about it because there was such a great need,” Roberts said.

Warren, of Alabama’s Mobile County Health Department, reiterated how difficult it is to pinpoint how much a natural disaster costs the department. Every storm is different, and variables include hazard pay for employees, the cost of gas for mobile units, any emergency supplies they need to order, and the cost to replace or repair damaged property.

“It really depends on how long the response period is,” Warren said. “How much damage has the agency suffered and how long are our services needed?”

The intense preparations that public health departments and safety net providers have undertaken may be more needed than ever this year. The National Oceanic and Atmospheric Administration predicts an active hurricane season from June 1 through the end of November.

At Mobile County Health Department, staff members are particularly worried about misinformation and complacency over a long and wearying season.

Erin Coker, an emergency response manager, said that disasters generate plenty of false information on social media. The health department hopes their mobile app will help — and will encourage residents to take the weather events seriously.

Because hurricanes and extreme heat are a constant in the Gulf Coast, people can become complacent, even when there is an evacuation order, Coker explained. Those with pets or livestock are less likely to leave. The same is true for people who don’t have reliable transportation, don’t have family in the area to shelter them, or can’t afford a hotel stay.

“Weather folks will predict the worst storm possible and people evacuate, and they come home and they don’t even have leaves on the ground,” Coker said. “So they say, ‘Next time I’m not leaving because you predicted this and that didn’t happen.’ It’s very hard to break that complacency and encourage them to truly watch the local news and not the Facebook news.”

Direct Relief has supported both Virginia B. Andes and the Mobile County Health Department with hurricane preparedness packs each year, as well as ongoing medical support.