A Tale of Two Floods: Strengthening Local Public Health System Response in Linn County, Iowa

By Julie Stephens, BA, Emergency Preparedness and Disaster Recovery Specialist, Linn County Public Health Department

Linn County Public Health (LCPH) is located in Cedar Rapids, Iowa and serves the state’s second largest county, home to more than 200,000 individuals. Linn County is also home to the Cedar River, which runs across the entire county, dividing the city of Cedar Rapids. In 2008, the Cedar River crested at 31.12 feet, shattering the previous record of 20 feet, set in 1929, causing devastating tragedy throughout Linn County and along other areas of the Cedar River.

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LCPH staff with state public health partners preparing response during 2016 flood.

Eight years later, in September 2016, above average rainfall impacted central and north central Iowa. According to the National Oceanic and Atmospheric Administration, in 2016, “the Cedar River in Cedar Rapids, Iowa, crested at its second highest level, [just] shy of the 2008 record, with water inundating large parts of the city.” Other areas of Linn County were also impacted. However, one stark difference separates these two flooding events: while the river crested at 21.95 feet, much of the resulting devastation felt in 2008 was largely avoided in 2016. This is the story behind how LCPH translated the lessons learned from the 2008 flood into Linn County’s new found resilience in 2016.

Incident Command System Structure and Emergency Operations in LCPH
In 2004, Incident Command System (ICS) training for LCPH staff began as a grant obligation. The training was initially met with some resistance, in part, due to the unclear role of LCPH staff in ICS. By the flood of 2008, four years later, only a small number of LCPH staff had been trained and staff were not familiar with common ICS terms and practice. This led to a poorly coordinated effort and a great deal of questions remained about internal public health ICS activation.

ICS training for LCPH staff was eventually required and expanded for all staff by the director, following the 2008 flood, to include ICS 300 and ICS 400, Intermediate Incident Command System for Expanding Incidents and Advanced Incident Command System for Complex Incidents, respectively. LCPH also coordinated several ICS training sessions and invited community and regional partners. This provided an opportunity to educate each other on various roles during a response and to develop a coordinated response plan. Since completing the newly expanded training requirements, LCPH employees have successfully activated the ICS structure in response to H1N1 (full activation) and large foodborne outbreaks (partial activation). As a result, staff awareness about the benefits of using ICS increased, prompting the health department’s managers and supervisors to make it a priority during employee orientation.

The next big test came during the flood of 2016, causing LCPH to implement full agency ICS activation. Unlike eight years ago, the section and command staff knew their respective roles and FEMA documentation templates were effectively utilized. Although LCPH identified areas of improvement following the 2016 response, it was abundantly clear that using ICS dramatically strengthened the agency’s capacity to communicate and work together during an emergency. It has also provided a framework to learn from past events and make needed improvements.

Environmental Health
In 2008, no clear protocol existed for communicating public health issues with the media. For instance, conflicting messages were provided to rural residents regarding the safety of their well drinking water. Residents were left unsure as to whether their well water had been impacted or not. Additionally, while free private well water tests were provided throughout the county, many lacked adequate education on why and when these tests should be implemented.

The communications planning provided by ICS training prevented the release of conflicting messages to the public during the 2016 flood. Additionally, GIS mapping was successfully utilized to identify impacted private drinking water wells. This allowed targeted visits by the LCPH field team to the impacted properties with educational information and water testing supplies.

Linn Area Partners Active in Disaster
In the wake of the 2008 flood, a group of organizations came together seeking to increase community resilience and minimize the impact of future emergencies. This alliance became the Linn Area Partners Active in Disaster (LAP-AID) promising to “share information, advocate for the most vulnerable, simplify access to service, and jointly resolve disaster-caused human recovery needs.”

LCPH became an active member of LAP-AID in 2010 and since, LCPH staff has created and conducted several LAP-AID drills. LAP-AID played a critical response role during the 2016 flood. Member organizations supported volunteer coordination, animal care, mass care, mental health, other access functional needs operations, and relayed communications through their network. LCPH remains an active member of LAP-AID and together, their efforts continue to support a coordinated disaster response and recovery plan, directly contributing to the resiliency of Linn County.

Communications & Safety
A number of gaps substantially lowering LCPH communication capacity and staff safety were illuminated during the 2008 flood. LCPH staff did not have access to portable radios and lacked familiarity with conference calling process, making it very difficult to communicate with other local jurisdictions. Although LCPH staff were equipped with public health branded vests, none of the available gear was approved for outdoor areas, posing a safety risk.

By 2016, LCPH was linked to a new county response radio system, which can also connect to a neighboring county. The health department also acquired branded hard hats and portable “public health” magnets attachable to personal cars, shirts, and safety vests. Conference call instructions are placed in an easily accessible location for all staff. Finally, all LCPH communications with the public are now streamlined through the ICS appointed Public Information Officer.

Conclusion
LCPH is just one of many organizations and groups that prepare for and respond to flooding events in Linn County. While many of these groups worked well together during the 2008 flood, a number of challenges limited their collective response capacity. As a result, the community moved forward to increase Linn County’s preparedness and resiliency in the face of future flooding events, a risk always in the realm of possibility with the Cedar River.

Throughout the process of implementing the various public health preparedness activities described above, in addition to increased resiliency, LCPH and Linn County also gained a number of valuable insights, summarized as follows:

  1. Do not wait for an emergency to gauge potential gaps and identify the necessary improvements across local public health preparedness activities, resources, etc.;
  2. Trainings and exercises (with both traditional and non-traditional response partners) strengthen the entire local public health system;
  3. After each response effort, the assessment of activities that worked and others that need improvement will strengthen community resilience when facing future emergencies; and
  4. Activities such as community health needs assessments, incident command training, public information, and injury prevention efforts increase collaboration across community partners, and not only contribute to a stronger emergency response, but also benefit day-to-day public health and productivity.

While many emergencies, flooding in particular, are often impossible to avoid all together, taking stock of these four lessons helped Linn County alter how their community was impacted as a result. By sharing their experience, LCPH hopes other jurisdictions can apply this information to limit consequences brought on by a similar event, only well before it actually occurs.

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