Environmental health effects of the Red River flood of 1997: interview with Jim Schothorst, environmental health sanitarian II, Grand Forks, ND.

Introduction

On April 18, 1997, a flood crisis struck the cities of Grand Forks, North Dakota and East Grand Forks, Minnesota as spring snowmelt and runoff caused the water level of the Red River to rise above its banks. It wasn't long before major dikes protecting these two cities began to fail. As sandbagging efforts were unable to contain the rising water, the Emergency Operations Center (EOC) ordered the lowest areas of both cities to evacuate. By the end of the day on April 22, over 47,000 people had been evacuated from Grand Forks and East Grand Forks. After the flood waters receded, it was determined that 80% of the 19,500 homes in Grand Forks suffered damage, as did all but 27 of the 3,500 homes in East Grand Forks. Although the amount of property damage sustained in Grand Forks and East Grand Forks as a result of the flood was enormous (an estimated $1-1.5 billion), the courageous flood-fighting effort there resulted in the loss of zero lives and kept the number of environmentally-related illnesses at a minimum.

The potential for environmental health problems in the aftermath of a flood like this is tremendous. Flood-related health risks include direct exposure to toxic chemicals dispersed by flood waters, inhalation of mold spores (and mold toxins) that proliferate on saturated indoor sheetrock, consumption of contaminated drinking water, consumption of spoiled food due to the lack of electricity for properly cooking and cooling it, spread of infectious diseases as sewage lift stations become disabled, and increased incidence of respiratory illnesses as a result of mass-sharing of evacuation shelters.

Six weeks after the flood waters receded, the Journal interviewed Jim Schothorst, an environmental health professional who worked on the front lines during both the pre-flood/prevention and post-flood/recovery phases. Jim is employed by the city of Grand Forks as an Environmental Health Sanitarian II. His story was not only fascinating, but full of lessons to be shared with anyone in a position of responsibility for public health and safety in the event of such disasters.

Q: What were your initial responsibilities once the flood crisis struck?

A: Once the Red River reached flood stage at 28 feet, I was "drafted" by the head of the EOC to serve as the sandbag transportation coordinator. The U.S. Army Corps of Engineers supplied the sandbags, and I organized their distribution via dumptrucks to the public dikes and to private citizens who called for them.

Q: How did you like doing all that?

A: It was exciting! Right towards the end, I worked from 18 to 24 hours a day for seven days in a row. In a two-week period of time, I had one day off and 98 hours of overtime. I was absolutely caught up in the adrenaline of it all. I remember one day, Friday the 18th, when I had been on for 24 hours. I went home to lie down and get some sleep, but I went right back to work after only three or four hours because the dikes kept failing...I just couldn't sleep.

Q: What caused such a tremendous flood?

A: It was a combination of heavy snowmelt from record snowfalls south of us and the geological properties of the Red River valley in Grand Forks. The Red River (of the North) flows north from Lake Travis in South Dakota, through Minnesota and North Dakota, and finally through Canada and into the Hudson Bay. There were record snowfalls last winter south of the Red River valley, and as the ice and snow melted and flowed northward (in our direction), the ice in the colder regions near the river outlet in the north hadn't melted yet. This caused all of the water to back up in the [Red River] valley, and created the flood.

Q: How did the flow of the river change?

A: The normal flow of the Red River is 6,100 cubic feet per second (cfs). At the peak of the flood, its flow was 115,000 cfs. On April 22, its crest reached 54.3 feet. To provide some perspective as to how high this really is, flood stage for this river is declared when the water level reaches just 28 feet.

Q: What were the first major public health threats due to the flood?

A: Right off the bat, we lost our municipal water treatment plant and lost 20 out of the city's 36 sewage lift stations, which became inundated with flood waters. The water treatment plant was predicted to be non-operational for four to six weeks. So our first priorities April 20th through the 23rd were to get water distribution systems set up for potable water and to set up sewage facilities (portable toilets). Also, 17,000 homes were without electrical power.

Q: How did you get potable water systems set up?

A: We contacted the National Guard and the Army Reserve (who had located themselves in the area) to utilize their water buffaloes. We were able to pipe water in from a rural water system that was still in tact just five or ten miles outside of town and store it in the water buffaloes.

Q: What about homes with private wells and onsite sewage systems?

A: That really wasn't a factor, because about 97% of Grand Forks is hooked up to municipal water and sewage.

Q: And the portable toilets?

A: Local vendors supplied about 300 of them, and we got at least 500 more from vendors outside the region. But it took us up to three days to dig the ones we got from local vendors out of the snow, ice and mud because they were stored outside on the north side of a building in a non-flooded area of Grand Forks. Anyway, once we got them out, we set them up in strategic areas of town.

Q: What about the electricity?

A: Well, we came close to losing power sub-stations, but never did. The reason so many people were out of power was that their basements got flooded and that is where everyone keeps their electrical panels. There was a critical shortage of electricians as people started to clean out their basements. They would call up to have a new panel installed, and were told it would be about a month before an electrician could get there. So people signed up on several different waiting lists at a time to get the quickest person out there. And we were hiring electricians from all over the place - even outside the region to help out.

Q: What happened as a result of the water system failures?

A: Well, for one thing we had to evacuate the local hospital - the whole medical center in fact - on Sunday April 20, because they definitely could not function without a water supply. Grand Forks has a large medical complex with clinics, a hospital, and rehabilitation centers. (It serves as the regional medical facility.) And six nursing homes got evacuated; occupants were at various stages of being able to take care of themselves. They got shuffled all over the place, and were scattered up to 300 miles away. This made it difficult for their relatives to visit, which was quite traumatic from a mental health aspect. There were no deaths, however, and basically no injuries. There was one fellow (an evacuee) at Grand Forks Air Force Base, about 15 miles out of town, that had a heart attack, but it is unknown if it was related to the flood. There were about 4,000 evacuees at this site alone.

Q: Was there an increase in the incidence of respiratory and/or diarrheal illnesses as a result of so many people living in such close quarters in the evacuation centers?

A: No, not really. We were concerned about the risk of transmission of respiratory and diarrheal illnesses, but we only had six cases of diarrheal illness out of 4,000 people at the evac site down at the air base. Who knows if that was related to something they ate there or just due to general stress. By and large, it was really a miraculous evacuation - no panic, very orderly.

Q: Who organized the evacuations?

A: The Emergency Operations Center (EOC)

Q: Is that a state-run organization?

A: Yes, it is state-run with a local director, Jim Campbell.

Q: What other organizations had a role in the flood-fighting effort?

A: A lot! There were emergency management people, law enforcement people, and lots of federal agencies - like the Coast Guard, the Army Reserve, the Army Corps of Engineers, the National Guard, the Air Force, FEMA [Federal Emergency Management Agency], etc. They all established a presence in town. Also, the CDC [Centers for Disease Control and Prevention] and the USPHS [U.S. Public Health Service] were here.

Q: What did the CDC and USPHS staff do?

A: For one thing, they assisted us in setting up the recovery and monitoring aspects of the contaminated basements, and this is still ongoing. With 80% of the basements saturated with water, there is a lot of concern about indoor air quality problems due to molds. An unbelievable amount of mold is growing! Sheetrock is an extremely fertile medium for these molds. Also, many homes (300-500) had their walls coated with fuel oil from overturned fuel tanks in their basements. It was terrible! This oil, once it got in the flood waters, coated everything as it rose, then again as it receded. It is a very permeating smell, and just soaks into things, making it very difficult to remove.

Q: Have any illnesses resulted from all this spilled fuel oil?

A: Some people have complained of smelling it while cleaning up, of getting nauseated and having headaches, but this is to be expected with an event like this. We have supplied thousands of NIOSH-approved surgical masks to those requesting them to clean out their basements.

One other thing, though, that happened because of the [spilled] fuel oil is that several small sections of our municipal water mains got contaminated. With all that fuel oil floating around, when a water main broke and created a siphon, the oil was then sucked right into it. This permanently damaged these sections, and they had to be replaced because there is no way we would ever be able to remove enough residue to run potable water through them again.

Q: I remember hearing something about a big fire downtown. Was that caused by any of this fuel oil?

A: I am not sure what the cause of that fire was, but it was horrible. On the 19th and 20th, there was a huge fire downtown that destroyed 11 buildings. Fire trucks had a very difficult time trying to find the hydrants, and about six firefighters got hypothermia trying to fight the fire. The Air Force brought in a crane helicopter with a 2,000-gallon bucket underneath it, dipped it in the river, and dumped it on the fire. They also sprayed fire retardant, which created problems once it got in the water that was settling all over people's homes.

Q: Have the CDC and USPHS been monitoring illnesses from all of these health threats?

A: Yes, definitely.

Q: What have they found?

A: CDC's comment was that there was less incidence of diarrheal and respiratory illnesses in the four week period after the flood than they would have ordinarily expected.

Q: Why is that?

A: I wish I could tell you, but for now the reason is unknown.

Q: What about other types of illnesses?

A: Well, they probably had close to 20 cases of carbon monoxide poisoning that occurred because people brought gas-powered power washers (high pressure washers) and generators (to supply light) down into their basements. They were using the power washers to blast off the muck, silt, and sewage from their walls and out of their basement drains. There have also been lots of injuries like lacerations and punctures from stepping on nails, dropping things on their feet and hands, etc. This is why tetanus shots were necessary - because of all the cuts combined with people handling so much contaminated debris.

Q: How did you administer the tetanus shots?

A: We set up mobile first-aid clinics and had people line up in mass. It was amazing - they all lined up, got nailed, and kept right on walking.

Q: It sounds as if most or all of the damage so far has been to personal property and town infrastructure, and that environmental health problems have been fairly minimal, even though water, sewage, and power were out for some time.

A: Yes, that is correct. Everyone did a really good job protecting the public health under such difficult circumstances. Damage has been measured mostly in terms of property loss so far. The major environmental health threats we experienced had to do with the lack of potable water, running water for hand washing, and latrine facilities. But fortunately, everyone followed instructions for the most part and stayed healthy.

Q: What kind of instructions did you give to people?

A: Well, for instance, a lot of restaurant owners wanted to re-open right away - at least the ones whose restaurants didn't suffer any structural damage. See, a lot of restaurants on the west side of town escaped physical damage but had no potable water. Some of them also lost electricity for two or three days, so we had to work with the owners on condemnation of the spoiled food. In any case, we let some of these restaurants open within two or three days after the crest passed over, so we set up temporary water facilities for them and gave them special operating instructions.

Q: How did you set up temporary water facilities?

A: We got the water from the rural water system, and piped it into temporary holding tanks - the water buffaloes.

Q: You started to explain the instructions you gave to these restaurant owners.

A: Yes, we set up new procedures for restaurants to operate with potable water from a tank with a very limited supply. Right away, one of the things you face is that you've got a maximum of 500 gallons available - maybe 1,000 gallons - and when you are running toilet facilities, dish-washing machines, and are doing extensive cooking and food preparation, 1,000 gallons isn't going to last very long. So, in order for a restaurant to open...it had to have portable toilets, a potable water source, single service items (plastic forks and paper plates) and a limited menu. Initially for that first week or so, there was no food handling allowed (the cooks had to throw burgers or steaks right on the grill and that's it), no salad prep, and no reheating of food products. Reheating requires a lot of handling, and the health department felt that with the lack of handwashing facilities, this was the best course of action. The majority of foodborne outbreaks (or about 60% of them) usually occur from improper reheating and cooling...the last thing we wanted was a foodborne outbreak among EOC staff, telephone [repair] people, etc., on top of everything else. This set of new procedures was as close as we could get to a pure HACCP system.

Q: Did you have these procedures planned out in advance? Was this part of a contingency plan?

A: Oh no, these guidelines were made up as the situation occurred. No contingency plan existed for something like this. This experience is unparalleled in the history of the United States. There has never been a community that was so inundated and that had such a large part of its population affected all at one time.

Q: What was affected the most?

A: The houses. Eighty percent of the basements in Grand Forks got flooded, and virtually none of [the homeowners] had taken any [of their] things upstairs where they could have been saved. Everyone in town was busy sandbagging to help build the dikes, but not taking care of their own homes. So once the water broke through the dike system, the majority of the basements in Grand Forks were destroyed along with the electrical panels, furnaces, and water heaters that people keep down there. In addition, almost all of the basements in Grand Forks were finished with family rooms, bathrooms, laundry facilities, bedrooms, recreation areas, etc. There is no word that can describe the amount of debris that was out on the berms after everybody cleaned up. It was just mile after mile of personal property. Also, because the majority of child day care centers were located in people's basements, nearly all of them were destroyed too. This created a huge problem for working parents that tried to go back to work - they had no where to leave their kids.

Q: Looking back, what were the most critical elements of the flood-fighting effort?

A: Besides the obvious things like team effort and cooperation, I would say cell phones! If it weren't for cell phones, we wouldn't have known where sandbags were needed because all the lines were down, especially in the days immediately following the crest. They were our only means of communication.

Q: What impact has this whole experience had on you?

A: Well, it really hit home how fragile our civilization is without power, without running water, and without sewage facilities - how dependent we've become on those things that we take for granted. This really shocked me into the realization of how important [the profession of] environmental health is and how easy it is for everyone to overlook us. The only time that our profession really gets in the paper is [during] these situations. You know, it's like that old saying where no-one notices you until something goes wrong. But because of this experience, I was recognized by the President and shook his hand. (I represented our department at a national press conference along with some other members of the flood-fighting and recovery effort.)

Q: Are there any other experiences or reflections that you would like to share?

A: Overall, the whole flood-fighting and recovery effort went remarkably smooth. We could never have planned for something of this magnitude. Each morning, the environmental health department had a meeting with USPHS and other government entities to assess things, establish a game plan for the day, [discuss] what kinds of things were witnessed the day before, and [decide how to] address those issues. For example, we found out that some of the septic haulers that pumped out the port-a-potties had been using RV dump sites at local gas stations. The problem with this was that the sewage disposal system was so fragile that we didn't want any extraneous stuff going into the system. As the water receded, the lift stations that were still functioning were pulling out basically nothing but water - whether it was sewage backup or flood water that had entered the basements. And with all that water going down the sewage system (every basement has a floor drain or two, and there were lots of bathrooms with plugs that had popped) any lift stations that were functioning were running at 100% capacity. Anyway, millions of gallons of water were coming into the system as the water receded, so we told them to go out to the sewage lagoons about four or five miles out of town and dump the port-a-potty waste there instead.

Another thing that we appreciated was that we had no resistance from the restaurant owners or food purveyors. In general, they were 110% supportive. They knew that without sewage facilities and water, we were all back to basic civilization. It took four weeks for the water to come back on. Everybody really got together, shouldered the burden, and did what was necessary.

If I had to do it all over again, I would have taken a whole day off just to clean out my basement, bring all the appliances upstairs, and sandbag around the windows. The whole five-week period surrounding the crest is just a blur... so many hours... and the magnitude... everything you see on TV can't even come close to describing the amount of personal property destruction and infrastructure loss that occurred here - it's just staggering.

Acknowledgements: The NEHA staff thank Jim for his time and effort so generously given while participating in this interview. We also salute the entire group of agencies that have helped and continue to help the people of Grand Forks recover from this great disaster. It is our hope that other environmental health professionals will be inspired by the heroic actions of Jim and his colleagues as they poured heart and soul into protecting the public health.

Jim sends a warm heartfelt thank you to Captain Rodney Coker, Commander David Mosier, and Lt. Commander David Blevins for their invaluable help during this disaster. These gentlemen became known as the USPHS "A" team for their roles in the recovery effort while assisting the Grand Forks public health department's environmental health division. He would also like to thank his supervisor, Wallace Helland and co-workers Richard Klockmann and Myron Larson. In addition, he thanks the Salvation Army and other charity organizations that helped the victims of this disaster, as well as the very generous Joan Kroc (widow of Ray Kroc, founder of McDonald's) in California who donated $15 million that was distributed as $2,000 per household that suffered damage. Another donation of $5 million was kindly given by a corporation that has not yet been identified, and he wishes to thank them as well. Jim also acknowledges the mayor, Pat Owens, who did an outstanding job of maintaining poise and composure during the disaster. She was a rock that everyone clung to throughout the whole flood- fighting and recovery effort. In addition, he thanks the U.S. Army Reserve, the U.S. Air Force, and the National Guard - without whose help it would have been impossible to survive this disaster the way that Grand Forks and East Grand Forks have.

Facts About the 1997 Red River Flood

City of Grand Forks, North Dakota

Area = 16 square miles Population = 51,000 (75% were evacuated) # of houses = 19,500 (approx. 80% of homes suffered damage)

City of East Grand Forks, Minnesota

Area = 4.5 square miles Population = 9,000 (98% were evacuated) # of houses = 3,500 (only 27 homes were spared damage)

River flow

Normal (annual mean) = 6,100 cubic feet per second (cfs) Peak of flood = 115,000 cfs

Crest

Date = 4/22/97 Height of water = 54.3 feet (flood stage = 28 feet)