Superstorm Sandy Mobile Outreach Program

State: NJ Type: Promising Practice Year: 2014

On October 29, 2012, Superstorm Sandy destroyed thousands of homes and businesses in Ocean County, New Jersey. The storm surge flowed inland and downed trees destroyed thousands more. The Ocean County Health Department’s (OCHD), located in Toms River, New Jersey, with a jurisdiction of 576,028 people. The First goal in the recovery process was to ensure the health and safety of first responders in the destroyed areas by providing flu and Tdap vaccinations, gloves, hand sanitizer and N95 masks via the OCHD mobile outreach vehicle going directly to the devastated towns. Each municipality was contacted to arrange this as soon as phone service was restored. The OCHD continued to reach out to the first responders for months following Sandy as communication channels were also hard hit by the storm. Goal two was to educate and guide homeowners and contractors about the dangers and remediation of mold. Many could not get into their homes right away due to dangerous situations such as flooding, snow, etc. Ten days after the storm, Ocean County was hit with over 12 inches of snow during a North Eastern storm. Destroyed homes were now covered and filled with snow. Mold was and would certainly become a major problem. In order for OCHD staff to answer the hundreds of calls regarding mold, our first objective was to train OCHD staff through a program designed by the University of Medicine and Dentistry of New Jersey which is now Rutgers School of Public Health. Two programs were designed; one for homeowners and one for code enforcement and environmental specialists. The second objective was to host this program throughout the county; although programs are still being held, from April 2013 through Labor Day 2013, the OCHD had hosted 16 programs throughout the county for both sectors. Goal three was to provide easily accessible Tdap vaccine and mold information to any person in Ocean County affected by the storm. The objective for this goal was by Labor Day of 2013 to have provided this service to every affected area by bringing the outreach vehicle from Friday to Sunday on weekends all summer. For each weekend site, press releases, website information, posters in local businesses, radio interviews, and municipal alerts, such as Reverse 9-1-1 and Nixle, were done to notify residents. Weekends were included as many affected homes are a second or seasonal home; this brought home owners down for cleanup on weekends. In addition, the OCHD mobile outreach was requested at Ortley Beach on three additional Wednesdays; this area being the epicenter of the storm. To assess the impact, records were kept of the number of flu and Tdap vaccines given, N95 masks, hand sanitizer, gloves and bags of information distributed. Additional flu vaccine is ordered by the OCHD each fall for the seasonal flu campaign, which was used.Tdap vaccine was donated and the other items were purchased before the storm through a bio-terrorism grant. The OCHD also put together bags of information including safe swimming guidelines, mold information, OCHD services, etc.This was done in-house. The New Jersey Department of Health published MOLD GUIDELINES FOR NEW JERSEY RESIDENTS; we received approximately 7,000 copies at no cost, over 5,000 have been distributed and is also posted on the OCHD website. From 11/5/12, 2,249 flu shots were given at municipal sites and over a thousand Tdap vaccinations during the summer mobile outreach. Many residents and responders had already received both vaccinations before the storm or come in for the vaccination at our clinics, which we now have 4 times a month. As this clinic is not considered part of the mobile outreach as anyone over the age of 19 can come in for the Tdap vaccination, the numbers of shots given have not been incorporated into the mobile outreach number. The OCHD has been promoting Tdap vaccinations, more so for the pertussis, over the past few years following a local outbreak of pertussis. The OCHD had N95 masks, hand sanitizer and gloves stored but they could be purchased easily. Without an outreach vehicle, many municipal buildings, libraries, businesses can be used to set up areas for information and shots. Staffing always included two employees, a nurse to administer shots and a health educator/environmental person to answer questions. Our objectives were met in that the program was well-received, OCHD created an awareness of mold dangers and information on remediation and we continue to provide Tdap vaccinations at our main site.
The OCHD employs over two hundred and fifty people, located in Toms River, with a total jurisdiction of 576,028 people. Non-Hispanic white persons constitute 93.2% of the population compared to 74.1% in the state of New Jersey. 6.7% of the population is under the age of 5, 23.3% are under 18 years and 21.1 are over the age of 65. Hispanics comprise 8.6%, Blacks, 3.45 and Asians, 1.9%. The median household income is $59,620 as compared to New Jersey’s at $69,811. The Unemployment rate is 9.8%. 19% children live in poverty and 9% of the population, live below the poverty level. It is a coastal area bordered by the Atlantic Ocean with many waterways dissecting the county. The County is the second largest in the State in terms of geographical size. The public health issue that was targeted was in response to Superstorm Sandy, it created a need for emergency response and outreach in the county. The safety of the first responders and residents of affected Sandy areas was first and foremost for recovery from this disaster. About 60% of the county was directly affected by the storm because of location of the population to the water sources. Of this total, 100% of affected towns were offered our services for the mobile outreach program, and about 80% took advantage of these services, although the services could be accessed easily by that 20% where we did not set up the mobile outreach. A storm of this level has never occurred in Ocean County before, so unfortunately, predictions of the outcome from a crisis event such as Sandy is not possible. Data collection was started from the incoming calls that were being taken at the OCHD as well as the location of the person that was calling as well as the topic of the questions being asked and were recorded for research. Tools that are used to respond to an emergency situation, to be as effective as possible, occurred as the crisis was happening. By taking a data collection of the calls coming into the OCHD, it told us exactly what the problem was. A large call volume of mold questions and availability of tetanus shots came to be one of the biggest safety issues known to us. Not wanting anyone to go back into their home unless it was safe was crucial to our mission. The OCHD decided it was imperative to go to the population affected to create the most effective and timely help to the municipalities. The OCHD then developed an operation to get the information available to all first responders and residents affected by Sandy. The creation of a mobile outreach initiative seemed like the best approach to this specific emergency situation. The call data was analyzed so that it could best represent the need. The data detected the largest need of the affected residents was to educate about mold and offer Tdap vaccine. The situation then began presenting itself in a manner of transportation. Ocean county does not offer many means of public transportation and due to the storm, many vehicles were damaged, so the OCHD decided to bring the program to the people in need of services. Although the mobile outreach response was in response to an emergency and was new to this county, reviewing the CDC Guide to Community Preventive Services gave guidance in our response. MAPP was also used in accordance to the disaster. It was imperative that we protected our emergency responders and residents from public health threats, from flu, tetanus and mold. Many of our residents are seasonal and with the damage from Sandy and were unable to get to their homes. Besides the fact that there was a gas shortage, most areas in the shore area had no electricity for almost 2 weeks or longer. Ten days after the storm when people were trying to get to their homes to assess damage done, Ocean County was hit with a Northeast storm in which we got over a foot of snow. As part of public health preparedness, according to the CDC Guide, the Ocean County Health Department needed to “prevent, protect against, quickly respond to and recover from health emergencies in a timely manner.” Ocean County Health Department staff, including environmental, administrative, health educators, public health nurses and emergency preparedness planning, discussed the necessity of reaching out immediately to our first responders. With flu season just beginning and the dangers of tetanus with the amount of debris, we came up with a plan to protect our first responders and residents. With no power or phone service, we tried using cell phones but most carriers were not providing service. Twelve days after the storm, electricity and phones were restored at the health department and our plan was put into effect. We continued to reach out to all local municipalities through the fall and winter as many of the towns were thoroughly devastated from the storm including their communication channels. According to the CDC MAPP, the five evidence-based strategies, when combined, can have a profound influence on improving health behaviors by changing community environments. This was used to ensure that the affected residents had knowledge of our program, that it was easily accessible, the money was spent properly, the residents had no barriers to the access and support was given. Media was used during the outreach program to notify and direct people of Ocean County to the sites of the locations of the Mobile Outreach Vehicle. Access was created by actually going to the affected towns and municipalities with the OCHD Outreach vehicle to make sure there was an absolute way of people affected by Sandy to seek help easily. Also with Hope and Healing, a door to door peer project, sponsored by the New Jersey Division of Mental Health and Addiction Services, Disaster and Terrorism Branch, through a Federal Emergency Management Agency (FEMA) grant, the counselors went, and still go door to door in every affected area, ensuring help and referrals to all affected people. The OCHD also coordinated the Mold Education program from UMDNJ for all of the Hope and Healing Peer Counselors. As the counselors were going directly into affected persons homes, both the Hope and Healing coordinators and the OCHD felt that they should be educated about mold, mold remediation and the knowledge of where to refer questions about mold. The OCHD also provided the Hope and Healing counselors with several thousand copies of the Mold Guidelines for New Jersey Residents for them to distribute. Point of purchase was used to make sure that there was enough valid and appropriate information to distribute among the affected communities. This created a way to ensure communities were being properly educated about the public health issues at hand. Price of the vaccine, N95 masks, gloves and educational materials for affected residents and first responders was free so it created no barrier for residents to come to our Mobile Outreach Program. Social Support and Services were available for all affected residents in Ocean County and referred to by Hope and Healing nonprofit organization and also gave referrals to the Mobile Outreach Program for those in need of our services. As we were in receipt of both flu and Tdap vaccine, had N95’s, gloves and hand sanitizer stored within our facility as a health care system, we were able to provide a medical preparedness response to this particular health emergency. The OCHD incorporated health messages through press releases, radio interviews, cable TV advertisements, website announcements, Twitter and municipal emergency communication systems such as Reverse 9-1-1 and Nixle. Each municipality that the mobile outreach was providing for also had the time and opportunity to announce the program in any manner that they saw fit, such as their televised Council meetings. OCHD was able to use our social marketing and health communication campaigns to further encourage vaccination and education. This program was developed quickly in response to a community and state-wide emergency. Ocean County, being the second largest county land wise, has limited public transportation with one bus line from New York City to Atlantic City. Many of the roads remained flooded or impassible due to downed trees and thousands of automobiles were destroyed in the storm. The OCHD provided a needed service in a timely manner. It is not evidence-based. By evaluation of the need in such a timely manner for specific public health issues, this created the ability for the outreach program to be so successful in such a short term period. This practice does not address any CDC Winnable Battles.
OCHD had three goals and multiple objectives for the outreach program. The first goal was to ensure the health and safety of first responders to the destroyed areas with the objective of providing flu and Tdap vaccinations, gloves, hand sanitizer and N95 masks via the OCHD mobile outreach vehicle to the devastated towns. The second goal was to educate and guide homeowners and contractors about the dangers and remediation of mold. The objective for this goal was to host this program throughout the county; although programs are still being held, from April 2013 through Labor Day 2013, the OCHD had hosted 16 programs throughout the county for both sectors. Goal three was to provide easily accessible Tdap vaccine and mold information to any person in Ocean County affected by the hurricane. The objective for this goal was by Labor Day of 2013 to have provided this service to every affected area by bringing the outreach vehicle to municipalities when most accessible according to the community itself. To achieve these goals, a plan was created to ensure that the mobile outreach program had full capability of getting to the affected population. Items were purchased or donated to OCHD to ensure our goals were met. Once the program was officially developed a protocol was created to have stability in the program. The implementation of the mobile outreach program started with phone calls placed to the mayors and business administrators of the communities surrounding the shore. We wanted to know their needs, an assessment of the damage incurred and how we could help them. In addition, during the immediate aftermath of the storm, the OCHD Environmental Unit received many cases (35) related to oil spills, leaking/sunken vessels, and storm debris. The Unit worked with both the New Jersey Department of Environmental Protection (DEP) and the U.S Environmental Protection Agency (EPA) in assessing damage done by the storm. Due to these concerns, packets of information were also made for every business affected by Sandy. Every restaurant was contacted and also guaranteed that the OCHD would work with them to be compliant with the law and getting them to open as soon as they could. Hundreds of homes were missing. It was important to monitor the water for oil and gasoline leaks and other things that may have washed into our waterways. Safety of our responders to any storm situation was paramount. The OCHD then arranged site visits throughout Ocean County ensuring that it was the best times and places for accessibility to be at its greatest. First responders and residents were vaccinated as needed and the need for the mobile outreach in our county seemed to increase. The call volume to OCHD increased as residents started to return to their homes. Residents started noticing the severity of the mold damage, and not knowing how to destroy mold safely the residents turned to the OCHD. As a health department, this was a major concern and decided to take the mold education, N95 masks, hand sanitizer and gloves to the population that was in crisis. Mold information continued to be first on our website news. To ensure that Ocean County residents were aware of this mobile outreach a weekly press releases of our locations were published on our website, weekly radio interviews, radio PSAs, NIXLE, Twitter and reverse 911 actions to make sure the word was out to our communities. Signage was also used for promotion and put up the week before the mobile outreach program got to each site, to ensure people knowing about the program. Also by taking a look at the population affected, the OCHD decided to rotate locations by alternating from a northern location followed by a southern location and back and forth until we reached all the areas of the OCHD jurisdiction. The staff also gave out a variety of important educational information regarding influenza clinics, mold classes offered on NJLMN, prescription medication drop off sites, etc. Program preparation included at least two OCHD employees, a health educator/environmental specialist and a nurse. The driver was to ensure the mobile outreach unit was gassed and fully stocked with outreach bags, gloves and masks. The nurse was to ensure the outreach unit was fully stocked with all necessary clinical supplies such as Sani-cloth and Clorox wipes, large hand sanitizers, under pads and table pads, large and medium gloves, band aids, alcohol prep pads and syringes. Also right before the departure pack a cooler with ice packs, a thermometer and vaccine. Once the OCHD arrived at the site, the outreach vehicle was strategically parked according to the location, to maximize the visibility for the view of the public. The store or business owner was then informed of arrival, and the health education and vaccine distribution began as soon as the set up was complete. Set up for the nurse included standing the vaccine sign up at the site and setting up the necessary clinical supplies. The driver was also the health educator/environmental specialist, which was there to support any questions and educate the communities on relevant information. The health educator gave out bags, gloves and masks and kept a tally of the distribution. The forms for the Tdap vaccine were also given out by the health educators for people who were interested. The nurse made sure that the demographic information of the clients form was accurate and gave the vaccine accordingly. The clients were also advised not to drive a vehicle for 15 minutes after the vaccine was administered. The temperature of the vaccine was checked every thirty minutes to ensure it was within range. At the conclusion of the program the vehicle was then packed back up accordingly and a tally was then conducted of all vaccines given and a program summary form was completed. An inventory check was then done and reported and all information and reports were given to the health educator for a report to the administration. Once returning to the OCHD the driver restocked the outreach vehicle of any supplies that will be needed for the next location and the vaccine gets placed in the refrigerator by the nurse with the appropriate measures. The timeframe for this outreach program was from the day after the closure of shelters which was dated November 4, 2012 to September 7, 2013. This practice continued throughout the summer and as part of sustaining this program, we continue to offer Tdap at the Health Department and will offer Tdap and flu at many of the health fairs that continue through the county. The OCHD staff has let it be known to all municipalities that staff is always available to speak at any of their functions and also at any service organizations. It is important for municipalities to know that we will continue to provide needed services. A collaboration with Barnabas Health, whom received a grant from the New Jersey Division of Mental Health and Addiction Services, though FEMA, in partnership for the Hope and Healing Project, whom which provided peer counseling door to door in affected areas, and gave referrals to the OCHD Mobile Outreach program. OCHD also trained their counselors regarding mold issues, providing mold guideline books to be distributed and other resources available. Barnabas Health partners with OCHD frequently and by doing so many more people that were affected by the storm used our services because of the referrals from the door to door counseling. Partnering with different organizations helps create a bond with not only the organization but with the community as well, by doing so you gain trust with the people of the county. Knowing that OCHD partners with places like Barnabas Health, assures residents that we also work with their actual health care providers and local hospitals in our initiatives. In addition, Ocean County brought together the Ocean County Long Term Recovery Group (OCLTRG), which has now become a 501-C3, with an office and dedicated staff. The OCHD reports to the OCLTRG with updates and through this group, our mobile outreach was also promoted. One of the members of the OCLTRG is Deborah Heart and Lung Center from Browns Mills, New Jersey, just west of Ocean County. They have been providing pulmonary lung screening at some or our outreach events and other event as they screen for mold exposure. They have been an excellent agency to collaborate with addressing Sandy. Except for the cost of salaries and overtime, the cost of the program was minimal compared to the amount of devastation that was being addressed. The total cost for salaries and overtime came to $21,878.20 and the cost for gas and maintenance of the outreach vehicle came to less than $1,500.00. Also, right after the storm when we were vaccinating first responders with flu and Tdap vaccine, the OCHD was reimbursed by FEMA for the costs incurred. The mold information books were donated from the New Jersey Department of Health, which published MOLD GUIDELINES FOR NEW JERSEY RESIDENTS,; we received approximately 7,000 copies at no cost, over 5,000 have been distributed and is also it is available on the OCHD website. The flu and Tdap vaccines were donated or pre-purchased prior to the storm. Additional flu vaccine is ordered each fall for the seasonal flu campaign, which was used. Tdap vaccine was donated and the other items were purchased before the storm through a bio-terrorism grant. The OCHD also put together bags of information including safe swimming guidelines, mold information, OCHD services, etc. The only cost incurred to the agency was paper which was less than $30.00 and Ziploc Bags for the N95 masks and gloves that came to less than $12.00. The N95 masks, hand sanitizer, gloves, and syringes and pads were already on hand for emergency preparedness that had also been given to the OCHD by the New Jersey Department of Health. The Mobile Outreach Program was implemented by having the appropriate and trained staff, supplies and information available for the affected residents. Implementation was the main focus to create the valid results that it did. First responders and residents that were affected were offered services in a timely and appropriate manner leading to the success of the implementation. Being able to reach all attempted goals and objectives was important for all devastated throughout the shore communities, to be healthy and safe after the disaster.
The value of the mobile outreach program after devastation of this level is immense. The OCHD Mobile Outreach Program can be replicated easily by other LHDs. When the majority of a population under your jurisdiction is in crisis and the crisis is identified in a timely manner, it helps solve the public health issue faster and more direct. The process in reaching out to the communities, identifying the needs, setting up vaccination dates, moving forward to then vaccinate residents and educate them and environmental workers about mold, working with the communities to set up the mobile outreach were all successful in such a short period of time. The OCHD made up a team of health educators, health planners, public health nurses, environmental specialists and administrators to effectively provide these services. Each had a role in the process. Health Educators designed brochures based on the needs, packed bags to go in outreach vehicle and were trained in mold issues. They also needed to make sure the van was fully gassed and stocked with the outreach bags. Chairs, tables and a canopy were kept in the van. Health educators were considered “clinic managers” in that each day outreach was provided, health educators retrieved the vaccine from the OCHD, recorded number of doses taken, packed it in coolers and returned it at the end of the day. Health Educators were also responsible for the break-down of supplies and to list needed supplies. Upon return to the OCHD, they were to return the vaccine to the refrigerator at the OCHD and sign it back in as indicated in the Vaccine sign-Out Log. Nurses made sure that the outreach vehicle had syringes, alcohol preps, Band-Aids, vaccination forms to be signed and the Vaccination Information Sheet about Tdap, sani-cloths, large hand sanitizers for personal use, underpads and table pads, large and medium gloves for their use, and ice packs. The nurses were also responsible for setting up the standing vaccination sign by the van; these were made during H1N1 and kept at the OCHD. Nurses needed to review the Tdap vaccination form for contraindications with the client; if pregnant, client must have a doctor’s note and be in third trimester and vaccine could be given to a breastfeeding women. Nurses were to instruct clients not to drive a vehicle for 15 minutes after vaccination and to report to nurse if side effects were experienced within that time. Nurses needed to check vaccine temperature every 30 minutes to ensure vaccine temperature was within range. At the end of the day nurses were expected to tally all clients’ forms and complete the program Summary Form, inventory all vaccine and supplies on the Vaccine and Supply Inventory form and provide to the driver/health educator all information for a report to Administration and to ensure an adequate amount of supplies for subsequent programs. Health Planners retrieved N95 masks, gloves, hand sanitizers and helped put together bags for the outreach vehicle. Environmental specialists filled in if health educators were not available and also answered the thousands of calls coming in to the agency. By being able to go to the municipalities and offer them services in time of need is important to any LHD. Records in Excel were kept after each outreach event which included location, date, number of Tdap and flu vaccinations, number of bags, number of additional N95 masks requested, and staff, to determine the outcome of each event. At each event, pictures were taken for local newspaper publications which were submitted weekly with information for those who may have missed the program on where they could get the vaccinations and information. All information sheets, including West Nile Virus information, safe swimming guidelines, OCHD clinic services, safety measures when entering a home, mold information, were also posted on the website. We received many calls after each site where people may have missed the opportunity. As we had the entire summer scheduled for outreach, we could refer to the next sites or they could come to the OCHD for the Tdap vaccination or if they just wanted information, they could visit the website. During this time, the OCHD also opened a Twitter account which also posted sites, mold information, Tdap clinics, etc. The OCHD continually reached out to Mayors and Business Administrators and to this day, still does, to offer our services. We are aware that many communities are still affected and found that using our mobile outreach vehicle is an efficient way to provide some of the needed services. Most of the sites that we used, except for one municipality, were in excellent locations for the public to access. This was more determined by the Mayor or Business Administrator of the municipality. We felt that we were able to reach the targeted population by providing this service from Friday to Sunday. Not only was it appropriately advertised, the program was accessible to weekend residents. Although we would have liked to have had more people vaccinated against Tdap, there is no way of us knowing who received the vaccination recently, such as before the storm. Also, in the many calls regarding the Tdap vaccination, we found that many had vaccinated in the last couple of years so they did not need another. Many of our summer residents are from Northern New Jersey; we would have no way of knowing if they had the vaccination recently or received it from their primary care provider at the primary home. We had many calls from people seeking mold information and when we asked them about the Tdap vaccination, they had already received it elsewhere. For certain, we know that we created an awareness of the dangers of mold and information about mold remediation. Individuals who do mold remediation in New Jersey do not have certification for this specialty. We received over 700 calls regarding “who to call” and although we could not give names of people who do this, we were able to walk them through the Mold Guidelines for New Jersey Residents, which gives many checklists on mold assessment, mold remediation, questions to ask, what to avoid, etc. Legislation has been introduced; staff from the OCHD has submitted letters of support to their legislators regarding this legislation and we certainly hope if this situation arises again, we will have certified people that we can trust to do this. Although the New Jersey Department of Health offered a list of mold contractors, none of them were vetted by the Department of Health, they just put their name on a list for the public.
Sustainability of the program is essential to continue to improve the quality of life of Ocean County. Being able to successfully continue a program is based upon availability of resources; which are sustained by collaborations and adequate funding. In this case, the program was continuously functioning by both of these factors. Lessons were learned for future emergency situations of this nature, as well as the continuation of the program as residents slowly start to reside back into their homes. We were very fortunate in that right after the storm, we had flu vaccine in stock. As flu shots are offered everywhere these days, we purchase vaccine to bring to our many older adult villages but also to have a supplemental stock for use. We also found grants available for us to get the Tdap vaccine for free. After 9/11, our Emergency Preparedness Unit received thousands of N95 masks and gloves so these items were in stock already and at no cost. Also we periodically receive thousands of bottles of hand sanitizer for free from the New Jersey Department of Health so they were also available. Internally, as we budget for the upcoming year, we will look to see how much to request for overtime plus differential pay. Plus those who were working on the outreach needed to code this correctly, as we have received grant moneys towards Sandy Outreach. Some logistics were troublesome such as the clinic manager needing to drive from one end of the county to the other to pick up and return the vaccine when the weekend outreach was being held near their home. As we always knew ahead of time who was on schedule each day, including the nurses, we made sure who ever lived closest was responsible for picking up and returning vaccine. Also as the health department is closed on weekends except for the Home Health Nursing Division, we made sure that whoever was coming in for the vaccine had the phone number to call to get into the building. In the future, it might be beneficial to expand the outreach, possibly the number of days, if we had cooperation from our local area hospitals or they may want to set up clinics at their sites as supplemental vaccination sites. The OCHD feels that is was extremely successful in its outreach program and the awareness created about mold and other storm issues. Information was updated daily on the OCHD website in addition to ongoing Sandy information daily on our local radio stations and local newspapers. Our local radio station, which not only covers Ocean and nearby counties, is owned by the company that owns New Jersey 101.5 which is broadcast all over the state of New Jersey. Right after the storm we hosted a 4 part series on recovery and the importance of flu and Tdap vaccination which not only is broadcast statewide, the interview is posted on their websites. For this past September’s National Preparedness Month, with the five Mondays in the month, the OCHD once again did a five part series on preparedness including our still, ongoing recovery efforts. Stakeholders that were invested in the operation were a large part of how functional and successful the program was. Having Mayors, Business Administrators on board for the mobile outreach certainly was imperative. Also the mold outreach classes were attended by the code enforcement officers and building inspectors certainly helped the OCHD handle the amount of mold questions and situations that arose. Having most of the supplies needed to implement the program already on hand for emergency preparedness reasons, it was easy to provide and maintain. It created a simply sustained program which the stakeholders were necessary to continue the program by providing us with the resources that they did. Also by having the Tdap vaccinations donated or pre-purchased, this helped the vaccinations be readily available. Inventory has been done to replenish and update the supplies in case they are needed in the future. This practice has never been done before in the OCHD. Being able to develop a program of this nature has been nothing but beneficial to all of the Ocean County residents affected by the storm. The practice categories addressed were in the public health areas of emergency preparedness, environmental health education and immunizations. Having created a program that can offer public health issues of this nature easily available is just the start of being able to continue to keep reaching out into the community with the mobile outreach program for the aftermath effects of Sandy.
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