What do Hurricane Katrina, Superstorm Sandy, tornadoes across the Midwest and the Kamaishi earthquake in Japan all have in common? Food and water in affected areas may become contaminated with microbiological and chemical agents. Food safety risks are mainly linked to unsafe food storage, handling, preparation and ill employees. Processors with warehouses and retail stores that lack power cannot maintain proper temperature control. Foodservice facilities may find it impossible to cook the food they have during natural disasters due to a lack of facilities or fuel. Poor sanitation, including lack of safe water and toilet facilities, can compound these risks.

Food Safety Magazine asked U.S. Centers for Disease Control and Prevention scientists Martin A. Kalis, M.A., public health advisor, and Robert Blake, M.P.H., R.E.H.S., environmental health scientist, Alabama Department of Public Health’s Timothy N. Hatch, M.P.A., R.E.H.S., Debra Pandak, CSS-Dynamac, which assists federal, state and local agencies in responding to natural disasters, Rich Ritota, former program manager, Food and Drug Safety Program at the New Jersey Department of Health and current president of Food Safe Systems LLC, Mark S. Miklos, senior manager program compliance, National Restaurant Association, and former vice president of food safety & training for Waffle House Inc., and the Association of Food and Drug Officials’ Joe Corby how the food industry can best prepare for the next natural disaster before it strikes.

FSM: What are the main areas that require advance preparation to ensure safe food after a natural disaster hits? And who is responsible for carrying this out?  

Kalis and Blake: Foodservice providers will have immediate questions and concerns following any disaster. These will likely include: How do I protect my inventory? How do I maintain operations? How do I continue to serve healthy food? How do I continue the viability of my establishment?

The best way to address these and other concerns is before an emergency or disaster.

Prior to any emergency or disaster, regardless of whether it is natural or technological/human-caused, the community response partners need to understand their roles and responsibilities related to food safety based on applicable laws and established plans and guidance.

Contacting the local health department or food/restaurant inspection authority and asking about contingency planning is a good first step. If no planning has occurred for food protection after a disaster, food facilities can initiate these discussions with the health department.

Often, your professional organization, food/restaurant inspection authority or department of health makes an excellent advocate for initiating a multiagency/organization discussion to define roles and formulate custom plans for your community.

FSM: Around 30 states have Food Protection Task Forces comprising regulatory, academic and industry members, which are great resources for these types of planning issues.

Kalis and Blake: Other types of local first responders that conduct emergency preparedness exercises may be willing to include foodservice facilities. Plans can address topics such as how to protect food during long power outages and how to address flooding or sewage backups, spills and other events that could affect water quality. Foodservice facility managers will likely wish to make a list of all questions and concerns prior to attending an emergency planning meeting.

Organizations that might have an interest in this type of planning would include restaurant and food safety-related professional organizations, emergency management and public health agencies, humanitarian and nonprofit organizations (e.g., American Red Cross, Salvation Army), private industry (e.g., food vendors) and other partners and stakeholders (e.g., utility companies, media, Homeland Security, National Guard and fire and police departments).

Collaborative emergency preparedness training and exercising before an emergency are critical as these activities define roles, introduce the participants to each other and identify areas needing improvement before an actual event. Also, mutual-aid agreements can be put into place to help define roles and responsibilities and provide assistance during any emergency event that may affect food and water safety.

FSM: Building these relationships between food protection stakeholders prior to a disaster/emergency is very important.

Hatch: Advanced preparation is essential to the viability of any food establishment, from the supplier to the retailer. Plans should be done at the facility level with input from partners and regulators alike that factor in the needed elements for safe operation after a disaster. Some of the common areas are backup power, alternate water supply, innovative (and approved) methods of liquid and solid waste disposal and volunteer training on food safety. Just in Time (JIT) training for volunteer food handlers is a must. All too often, there are areas of food safety that are completely foreign to the novice food handler, and some are risk factors that must be taught in order to be fully understood. Private organizations do a fine job of day-to-day food safety training, but after a disaster, we do not have the time to conduct such, so JIT food safety training is always needed.

Pandak: I’d add FEMA [Federal Emergency Management Agency] and the U.S. EPA [Environmental Protection Agency] to the list. For example, FEMA ESF [Emergency Support Function] #11 addresses food safety during a disaster and the agencies involved. Also, the Red Cross has developed multiple “apps” that are available to individuals and companies that may require support in developing plans to respond to natural disasters and [that] support individuals and establishments post a disaster event at www.redcross.org/prepare/mobile-apps.

Corby: All disasters are unique and can present unique challenges to regulatory officials. Having a trained field staff with knowledge on preparing for natural disasters is government’s best hope for being able to respond effectively. Regulatory officials know their communities, the food establishments that exist there and industry representatives who can be called upon when a disaster strikes. Everyone is capable of playing a major role in disaster response and being familiar with all appropriate contacts is crucial. Handing out business cards during a disaster event is way too late.

Quick Links on CDC Food Safety and Emergency Response

Environmental Health Training in Emergency Response (EHTER): CDC has collaborated with federal, state and local public health and environmental health partners to develop the EHTER awareness-level course. During emergency response, state and local authorities perform many critical functions, such as conducting food safety assessments and inspections, testing drinking water supplies and controlling disease-causing vectors. This free 32-hour, introductory-level training provides an overview of environmental health topics and challenges faced during emergencies. For more on EHTER, see www.cdc.gov/nceh/ehs/eLearn/EHTER.htm.

Since 2009, EHTER has been taught at FEMA’s Center for Domestic Preparedness (CDP). CDC is collaborating with CDP to develop an EHTER operations-level course to allow environmental health professionals to use and practice response and recovery skills, including those related to food safety, in a disaster setting. For more information, see http://cdp.dhs.gov/training/program/hh/#ehterops.

Environmental Public Health Online Courses (EPHOC): EPHOC is an online/on-demand package of free courses for those interested in environmental public health. Among other topics, EPHOC contains a module on food protection. For more on EPHOC, visit www.cdc.gov/nceh/ehs/eLearn/EPHOC.htm.

E-Learning on Environmental Assessment of Foodborne Illness Outbreaks: CDC’s new e-learning provides training for food safety officials and others on how to investigate foodborne illness outbreaks as part of an outbreak response team, identify environmental factors and recommend appropriate control measures. For food safety professionals in the restaurant industry, this training provides information on investigating a foodborne illness outbreak from an environmental health perspective and on applying FDA guidelines for sanitation, food preparation and storage used in the foodservices industry. More on this free training can be found at www.cdc.gov/nceh/ehs/eLearn/EA_FIO/index.htm.

Environmental Health Specialists Network (EHS-Net): EHS-Net was established to contribute to a better understanding of the causes of restaurant-related foodborne illness outbreaks and to translate that understanding into improved prevention practices. EHS-Net studies and associated plain-language summaries provide valuable information about important restaurant food safety practices. This information can be very useful for the development of effective restaurant food safety interventions. For more on EHS-Net, visit www.cdc.gov/nceh/ehs/EHSNet/.

National Voluntary Environmental Assessment Information System (NVEAIS): NVEAIS is an effort to systematically collect, analyze, interpret and disseminate environmental data from foodborne illness outbreak investigations nationwide. The system will provide food safety program officials with information to help prevent foodborne illness outbreaks associated with restaurants and other food venues. For more on NVEAIS, see www.cdc.gov/nceh/ehs/NVEAIS/index.htm

FSM: What are the major challenges to advance preparation?

Kalis and Blake: One major challenge is ensuring key parties understand roles and responsibilities during emergency response and recovery. Usually existing laws and plans need to be supplemented with specific food and water emergency response plans (as described above).

In addition, resources for any emergency planning and training often are challenging to obtain and must be prioritized with other important public health issues. Addressing these “surge capacity” issues is a key element during planning.

Finally, getting the necessary time commitment from community partners and stakeholders to prepare for potential food and water safety issues during emergencies and disasters can be quite challenging, especially if staff members are limited and competing priorities exist within a particular agency, organization, company or institution.

Hatch: Planning and preparing for disasters is a foreign concept to many in the restaurant business. From the large chains down to the local restaurants, owners and operators have their hands full with day-to-day operations and attend to disasters as they happen. We have seen that advanced preparation is not only the smart thing to do but can lead to a strong business after a disaster. The faster an establishment can get back on their feet, the quicker they can begin preparing food for the community and those responding to assist in the recovery. Preparation is a smart business (and food safety) decision.

Pandak: When developing plans, the potential influx of relief and recovery workers to an area impacted by a natural disaster should be considered. In some situations, a government agency may provide foodservice to feed relief workers, but not always. How to plan and be prepared for the pressure that operating commercial facilities will experience? Where will products be obtained to support operating food establishments? Those businesses that are able to operate will experience longer workdays and require extra staff to accommodate the increased number of people needing food.

Employing social media to access local government sites may provide the means for obtaining information following a natural disaster. Facilities should incorporate this into their planning and be familiar with local sites and the use of texting, Facebook, Twitter, etc. Social media also presents a means to communicate with employees regarding the status of foodservice provider(s)—texting may be one of the only ways to communicate early on following a natural disaster when Wi-Fi and Internet connections may be down. This may be the only way to coordinate with your resources, including vendors.

Corby: Communication and transportation can oftentimes become a major challenge for responding in an effective manner. Many times after a disaster, cellphones will not function and roads may not be passable. What happens then? Understanding what to do before a disaster strikes can resolve this concern. Incident Command System [ICS] usually addresses this for management officials, but field officials may need to operate out of their homes and conduct establishment assessments within their home communities until communications can be established.

FSM: After a natural disaster hits, what are some commonly overlooked areas in need of consideration and improvement?

Kalis and Blake: Following a natural disaster, a key thing to consider is addressing food safety to reduce the risk of foodborne illness. The consistent availability of utilities such as electricity, natural gas, potable water and sewage containment is critical for ensuring that food is properly stored, prepared and disposed of in a safe manner. Such utilities are also necessary for ensuring proper sanitation and hygiene of those engaged in foodservice. If obstacles exist to ensuring sanitation and hygiene, alternate arrangements, such as the use of electrical generators, hauled/tanked water, chemical toilets and portable hand-washing stations, can be used. Managers of foodservice establishments are encouraged to make customized plans for contingency arrangements within their control.

Another area of potential concern is donated food. During an emergency or disaster, well-intentioned people within and outside of the community often donate food items for affected populations. Those responsible for food access and distribution will likely wish to follow existing food safety guidance regarding the donated items (or develop their own). Donated food items must come from a verifiable, safe source.

Food preparers will most likely desire to acquire food from a licensed and permitted facility. The risk of contamination in food prepared outside of a regulated environment is elevated, a problem that became a major area of concern following the devastating EF-5 tornado in Joplin, MO, in May 2011. Local authorities were challenged to assess or regulate donated food items because of limited staff and the sheer volume of food being donated by community members and outside sources.  
Finally, the foodservice workforce can be greatly impacted during an emergency or disaster. This was the case following Hurricane Katrina in New Orleans in 2005. People may be forced to evacuate or may have suffered the loss of their belongings and property, and thus may be unable to report to work or assist with feeding efforts in the affected community. Availability of the workforce is critical to take into consideration during the planning and preparation for food safety prior to the event. Advance arrangements to fill in behind absent employees is desirable. Addressing workforce support for essential food services is another key item in advance planning.

Hatch: To ensure food safety, contingency planning for alternate sources of water, power, waste (solid and liquid) disposal and inspector/responder safety is critical. All disasters are local, and it takes local solutions to mitigate the effects and quickly recover from an event. It is important for food establishment owners and operators to know who in their community, both public and private, can provide these alternate sources in the event of disaster. After the April 2011 tornadoes in Alabama, there were many success stories of foodservice establishments using approved hauled water, portable toilets and generator power to serve food safely and efficiently until normal operations could be re-established. This was done through preplanning and with the assistance of local health officials and emergency managers.

Corby: Various regions of the country are exposed to regional types of disasters—tornadoes are common in the Southeast, droughts and fires are common in the Southwest and snow and ice storms are common in the Northeast. Facility disruptions are always a major concern, particularly with the availability of potable water or the loss of power. Food safety concerns may many times be addressed with Temperature Control for Safety [TCS] foods, although the freezing of canned foods that may occur during a power outage or blizzard in colder climates places stress on the can because of the swelling that may occur. Closely evaluating food products is a major responsibility of the field inspector.

FSM: What does a foodservice facility need to consider before reopening? What are some necessary components of training that food handlers should receive on this topic?

Kalis and Blake: Before reopening an establishment, an assessment must be conducted by local authorities to determine the extent of damage to the foodservice facility. A facility’s capacity for food storage, preparation, service and disposal cannot be determined without an assessment. Depending on the severity of the emergency or disaster, some common foodservice facility challenges include decomposed food, lack of utilities and trash service, mold, lack of available workforce, limited availability of food suppliers, damaged equipment and infrastructure and the presence of rodents, insects and animals. Reopening criteria can also be established in the planning process undertaken before an event.

Foodservice workers may wish to seek educational and awareness training on disaster contingency plans for their establishment so that they can be prepared when an emergency or disaster strikes.

Looking Back at Hurricane Sandy

On October 29, 2012, Hurricane Sandy set its sights on New Jersey. The high winds and surge placed much of the state under a prolonged blackout. New Jersey’s preparation for such a widespread disaster was years in the making. As program manager of the Food Safety Program at the New Jersey Department of Health (DOH), I had paid close attention to the aftermath of Katrina, including the news headlines of food and water shortages, and the efforts to move food into the affected regions. It was clear that a major disaster or catastrophic event, whether accidental, natural or deliberate, could substantially disrupt the food supply and distribution network within the state.

The New Jersey food and agriculture sector had one driving objective in planning for a widespread emergency: Keep people fed. From this objective came Operation Food Distribution, which became part of the overall NJ Emergency Operations Plan. Plan participants included the NJ Food Council, Rutgers University, NJ DOH, NJ Department of Agriculture, NJ Office of Homeland Security and Preparedness, NJ State Police, Community Food Banks, FDA and other public and private sector players.

An important role for the NJ DOH was to assist the state’s retail and wholesale food businesses to prepare for, respond to and recover from a disaster. Much of the work was accomplished through our various food private sector associations and through funding to Rutgers. This is one example in which partnerships among the private sector, academia and the public sector are so vital. Our message to industry was to develop (or improve) a site-specific emergency plan covering preparation, response and recovery. One tool we distributed to our retail food sector was the Emergency Action Planning Guidance for Retail Food Establishments. The original document was produced by the Emergency Preparedness Committee of Council II during the 2004–2006 Conference of Food Protection and revised during the 2006–2008 conference. Concurrent with the above preparations for our food businesses, we worked with local health departments responsible for enforcing retail food rules in establishments such as grocery stores and restaurants. Their messages were: 1) facilitate establishments to get back into the business of feeding the public; 2) evaluate whether the foods made available to the consumer were safe and wholesome; and 3) focus compliance efforts on high-risk foods and inspection history.

The following list highlights many of the lessons learned in Sandy’s aftermath:
•    Target food investigations toward those establishments with poor compliance history.

•    Know where power is being restored.

•    Recognize the fragility of water and wastewater systems and the related impact on the seafood industry.

•    Maintain a centralized communication/command post with a designated point of contact to facilitate communication.

•    Enhance identification of congregate feeding sites.

•    Better share detailed projected surge levels to the affected community ahead of impact.

•    Disseminate open food and pharmacy establishment locations in real time to the public.

•    Improve and expand temporary food storage facilities, cold storage units, improved backup power and more food transport vehicles for food banks.

•    Ensure that retailers include fuel availability for key workers, prevent dumpster diving for food commodities and have protocols in place to address customer aggression in their emergency planning.

States should prepare for catastrophic events such as hurricanes and major storms by creating a toolbox of needs and actions. The interdependencies of various sectors are critical to ensure a safe and secure food supply. Actions to build a spirit of cooperation and communication among sectors, such as water and wastewater, energy, transportation, housing and communications/media, will go a long way in preparing for an emergency.

— Rich Ritota

FSM: We’ve found that reopening depends on who regulates the establishment, as the facility could be regulated by a state or academic institution. Whoever regulates the facility should do the reopening inspection.

Hatch: Reopening a foodservice establishment after a disaster must include closely working with the local health department. Reopening criteria are basically the same, but local ordinances may differ when a disaster happens. This is where preplanning comes into play, where the establishment owner has effectively communicated with health officials before any disaster to discuss reopening protocol and know what is expected of them by the regulatory authority. At a minimum, sanitation (cleanliness of the facility), power source (shore or generator), water supply and quality, and mechanisms for keeping food hot and/or cold should be addressed. As a rule of thumb, food managers should apply the K.I.S.S. principle—keep it simple, stupid—with their menus after a disaster to reduce the chance of a foodborne illness.

Pandak: Safety and a means of transportation for getting workers to a restaurant or other foodservice locations will be a big “what if.” Are routes to a location open? Is public transportation available and running on a regular basis? For those using their own vehicles, is fuel available?

Corby: In some cases, a foodservice establishment may be provided a temporary operating license or permit that would allow them to operate using alternative facility measures and a limited menu. This must be approved by the regulatory authority. At times when food products will need to be destroyed, this should be conducted in a manner that will not allow them to accidentally be put back into domestic channels; these products should be segregated from all others with a sign or posting which indicates they are not for sale. If an outside salvage operation is utilized to conduct salvaging, they should be licensed or approved by a regulatory agency; if the establishment will be salvaging themselves, then guidance should be provided to them to conduct this in a safe and orderly fashion.

Before reopening, all equipment should be clean and functioning properly. Equipment such as refrigerators, freezers, cooking equipment, processing equipment, dishwashers, water heaters and garbage disposals should be functioning properly. Establishments must ensure that proper temperatures for storing TCS foods at temperatures of 41°F or below or 135°F or above can be maintained. In addition, all facility operations must be functioning properly before the establishment reopens.

FSM: How should processors prepare, in terms of product storage, transportation, etc., to get safe food where it is needed after a natural disaster?

Kalis and Blake: The key is collaborative planning before an event strikes the community. Food processors and suppliers may wish to make advance arrangements to provide necessary food, water and supplies so that establishments can safely reopen. Once an event occurs, logistics can be extremely challenging, especially if infrastructure and transportation routes are severely impacted, such as during a major flood, hurricane or earthquake. Roads may be impassable and runways for air transport may be damaged and unusable.

Hatch: Stockpiling is not really an option due to temperature controls, storage space needed and expiration dates. In my experience, I see transportation to the affected areas as the number one problem due to road conditions and lack of supply from the wholesalers.

Corby: Transportation is the key issue here. Oftentimes, large processors will communicate very closely with emergency management officials for guidance. Processors also provide valuable assistance in managing these disasters as well. When potable water is needed, for instance, large dairies and beverage plants will commonly bottle potable water and make it available to impacted areas. Government officials should never underestimate the valuable resource that exists within industry.

FSM: How should retail facilities deal with product spoilage and associated issues (waste disposal, water, pest control) after a natural disaster?

Kalis and Blake: Retail facilities would benefit from having plans in place to address their individual emergency priorities prior to an emergency or disaster. One thing that can be expected at retail food facilities after a disaster is an increased presence of rodents. Arrangements could be made in advance for increased frequency and volume of pest control service, trash service and even chemical disposal.

Preparedness can be accomplished through developing standing contracts with companies or organizations that perform these services or through mutual-aid agreements prior to the event. Realistic estimates of volumes of trash, liquid and solid waste and other needs are critical so that proper plans can be put in place. Facility managers will likely wish to consider internal temporary arrangements also, such as covered trash receptacles/dumpsters and portable holding tanks/bladders for liquid waste, during their planning in case regular services are compromised or delayed.

Hatch: There must be some cooperation with the local officials and waste management to ensure prompt and complete removal of putrescible waste. And the rule of thumb should always be when evaluating the condition of food supplies after a disaster, “when in doubt, throw it out.”

Corby: There are a number of ways to delay thawing and spoilage that retail establishments should be aware of. These include the use of backup generators to provide electricity, the use of blankets, quilts or newspaper to cover refrigerated or frozen foods stored in chest-type compartments, using alternate refrigeration such as refrigerated vehicles, the use of dry ice or packaged ice or placing perishable cold foods in the freezer to delay thawing.

Retail firms should consult with regulatory agencies concerning the possibility of using alternative potable water sources, hand-washing facilities and portable toilets.

Pests can become an issue of concern as well following a disaster, and operators must ensure the establishment is pest-free. Consulting professional sources should be considered.

The Industry Perspective

The first step in any successful respo