Will pledged reviews of deadly heat wave response prevent deaths next time?
Oregon and Multnomah County officials have pledged to undertake comprehensive reviews of their response to the unprecedented June heat wave suspected of claiming 115 lives in hopes of beefing up their emergency response and avoiding a similar outcome the next time around. Gov. Kate Browns office said Friday that she had directed the Office of Emergency Management to complete an expedited review involving multiple state agencies by the end of the month. Meanwhile, officials from Multnomah County, where the vast majority of the fatalities took place, said they would be conducting detailed death investigations that would inform a deep review by all departments to more effectively target resources in future events. This is not the first time the county has undertaken a so-called after-action report after a heat wave. It did so after a string of scorching days in early August 2017 that tested what were then fairly embryonic plans to respond to extreme heat events. But that review, which is referenced in the countys playbook for responding to extreme heat, amounted to little more than a vague set of meeting notes asking a series of open-ended questions and offering no concrete conclusions. Chris Voss, Multnomah Countys emergency management director, said the review of the event four years ago, when temperatures hit 103 and 105 degrees, did not provide the typical thoroughness of an after-action review and indicated unfamiliarity with the document. He said hes confident the new review, examining action when Portland set highs for three consecutive days, ending with a blistering 116-degree record, will be far more thorough. Meeting notes from the daily coordinating calls among agencies during last months heat wave make it clear that Multnomah County mobilized an unprecedented response to the extraordinary event. It launched a broad, multi-lingual information campaign to warn residents of life-threatening conditions. It fielded an army of volunteers to provide water and cooling supplies to vulnerable populations in their homes and on the streets. And for the first time, it opened three cooling centers around the clock, supplemented by daily hours at local library branches. Yet its also clear that much of the decision making was on the fly, and it failed to avert dozens of preventable deaths. As of Thursday, the county had identified 71 suspected heat deaths, including 46 that already have been confirmed. The countys written Standard Operating Procedures for responding to extreme heat, for example, did not include clear directives on what cooling centers needed to be opened, where, when, and based on what triggering point. The county only announced its decision to operate the cooling centers round the clock the day before the heat wave arrived, according to meeting notes, leaving it scrambling for volunteers to staff them. And while city and state officials were referring residents to 211, the nonprofit that runs it didnt update its phone system to easily direct callers to information about the centers or transportation until Sunday afternoon, the second day of extreme heat. The city of Portlands Bureau of Parks & Recreation, meanwhile, was not prepared to open its community centers as cooling spaces. That inaction came after an inquiry about the possibility from the head of the joint city-county office for homeless services, said Julie Sullivan-Springhetti, a county spokeswoman. We are not planning to use community centers as cooling centers for this immediate heat wave given where we are with reopening and staffing, Cynthia Castro, policy advisor to City Commissioner Carmen Rubio, told other city and county officials in an email two days before temperatures in Portland hit 108 degrees. However, we are planning to be ready to again provide community centers as cooling site (sic) later this summer if needed, she continued. The timing is just not great for us right now.  Voss said the county is starting its reviews now, and he has several meetings scheduled in the next two weeks to drill down on its communication and sheltering strategies. The review will include one-on-one interviews with key people and a survey of all staffers to determine what worked and what didnt, he said. It will also be studying the circumstances of each fatality to inform that review. The level of injury is weighing on all of us and causing us to look even harder at every tool we have in the toolbox to mitigate some of those impacts, Voss said. This is the opportunity to do the critical thinking for each aspect of what we do. This is a game changer. This event is certainly going to cause us to shift in a lot of ways.  Low probability event  Although the impacts of climate change are clearly evident in the states ongoing drought and increasingly destructive fire seasons, an extreme and deadly heat wave has historically been considered a low probability event. Indeed, Oregon has been viewed as a likely climate refuge, not one of its foremost victims. Every five years, the county updates its Natural Hazard Mitigation Plan, which catalogues the frequency, severity and risk exposure of various natural hazards. Previous versions have focused on earthquakes, rain, snow and wind events, thunderstorms and hail, landslides and even the states infrequent tornadoes. But not extreme heat. In 2012, extreme heat was briefly mentioned in a chapter describing other hazards, but it noted that the level of risk posed by these other hazards is much lower than for the five major hazards and in most cases the level of risk is nearly negligible.  Multnomah County is subject to occasional periods of high temperatures, the report said. However, public response to extreme heat situations is for emergency responders and public health staff. There are no obvious mitigation action items to reduce the impacts of extreme heat on the residents of Multnomah County. Overall, the level of risk posed to Multnomah County by extreme temperatures is low.  The 2017 update didnt change much. It mentioned climate change, and said models did project more high heat days. As temperature and precipitation patterns change, there is likely to be more data about severe summer weather events, including drought. Future iterations of this plan will assess the planning areas risk to more severe weather events as data becomes available.  An update is due next year, and Voss said it will likely look different. A lot of those are based on our historic events so we use that to guide us, he said. This event is now part of our past in a way where it will very much force us to look at these types of heat waves in a different way.  We didnt have this on our radar in a way that now we do.  The Oregon Climate Change Research Institutes regular climate assessments for the state, by contrast, have consistently projected an increase in hot summer days and warmer overnight temperatures  a critical factor in the lethality of the events. The network of climate researchers has also predicted that the frequency, duration and intensity of extreme heat events will increase and lead to more deaths. The 2021 version forecast that if current greenhouse gas emission levels continued through the century, the number of days in Multnomah County with a heat index over 90 degrees (which accounts for humidity levels) will increase from a historical average of four days between 1971 and 2000 to 23 days by mid century. That increase, the study suggests, will increase the incidence of heat-related illnesses and deaths, particularly among the elderly, children, people with chronic illnesses, outdoor workers and people of color. The assessment cited other research which concluded that without any adaptation, the number of heat related deaths in the United States would increase by 422% by 20312080 relative to 19712020. And even with full adaptation, including a number of individual and policy interventions, heat related deaths were still expected to increase by 57%. Erica Fleishman, a professor at Oregon State University and director of the center on climate change, said she doesnt think there was a failure by public health and emergency management officials to plan for a heat event of this magnitude. Portlands previous high had been 107 degrees. It was off the charts, she said. No one expected temperatures were going to be that high. I dont think its unreasonable that there wasnt more preparation for this. Theres no negligence in not planning for temps over 110 degrees in Oregon.  Indeed, as Voss noted, in a world where temperature records are typically broken by one or two degrees, Portlands was nine degrees higher than any previously recorded, and 14 degrees higher than any previous day in June. Fleishman also said current climate modeling is not good at predicting if the frequency of such events will increase or whether last months heat wave should set a new baseline for public health officials. Right now its more in the random realm, she said, but there is atmospheric research going on to tease out any signal that these types of events may become more common. Climate change is destabilizing a lot of systems that we thought were fairly stable, she said. Its very difficult to predict the average and the deviation from average. Its difficult to say were going to get to a new normal because were not looking at a new equilibrium any time soon.  Angus Duncan, the former chair of Oregons Global Warming Commission, says thats why many observers have stopped using the term climate change, which makes increasing temperatures and their impacts sound predictable, rather than the extreme and seemingly anomalous fluctuations that have been seen. A more descriptive term, he suggests, may be climate disruption. The general expectation has been incremental change, he said. But you cant predict how the weather is going to react to climate change.  After action report  Portland recorded 13 days of at least 100 degrees between 2010 and 2020, with its worst stretch the two days in August 2017 when temperatures eventually hit 105. One year to the day after, county officials finalized a four-page document titled, Hot Weather Response After Action.  The document is not a formal report but instead a series of often-contradictory notes that hardly analyzed how officials responded. It said coordinating calls among groups such as the county, TriMet and the Portland parks bureau were helpful but officials need to develop a menu of response options.  The document later rebuffed the notion of clear parameters for specific action, at one point saying no actions should be tied to thresholds.  If a threshold does not constitute action, then say that; if thresholds can have a variety of options, list the applicable options or state the following options are in the purview but none of these will be implemented at this time, the document says. Flash forward to the unprecedented heat wave last month, when city and county officials discussed whether to open park community centers as cooling centers. The city ultimately decided against it. Rubio said the parks bureau was forced to lay off over 700 employees because of the impact of COVID-19 on its programs, and did not have sufficient employees to staff its community centers in time for the heat event. I will ensure, in coordination with the County and other City bureaus, that Parks will be ready for the remaining weeks of this summer if and when needed and going forward, she said in an e-mail. Never again can Portlanders go without appropriate shelter or services from record-breaking temperatures. Period. The Parks bureau will be ready with everything at our disposal.  County officials, meanwhile, did not open additional overnight cooling centers either, saying none of the three ever reached capacity. Looking at the long term, the city of Portland and Multnomah County do have a detailed and regularly updated climate change adaptation strategy that contemplates extreme heat events and measures to deal with them. The plan includes 170 directives ranging from residential retrofits and weatherization programs to planting trees in low-canopy neighborhoods to reduce so-called heat islands. Many of those efforts are underway, but they are long-term solutions that dont address immediate needs, like providing air conditioning to the 20% of Portland households that dont have it or retrofitting high-rise buildings with no cooling systems  expensive endeavors that may exacerbate greenhouse emissions. Likewise, the state of Oregon has developed a Climate Change Adaptation Framework to identify the most effective government response strategies and guide investment of resources. It too is a compendium of long-term actions in anticipation of future changes, but includes little that will inform emergency response and coping strategies for specific, near-term events. State and county officials acknowledge more needs to be done right now. In an interview last Sunday on CBSs Face The Nation, Oregons governor praised local officials efforts to get the message out about life-threatening conditions, establish cooling centers and provide water and other supplies to vulnerable Oregonians. Unfortunately, we still lost too many lives. Absolutely unacceptable, Brown said. We always do reviews to see what we can do better next time.  The Office of Emergency Management will hold a news conference Monday to discuss the statewide response to the recent heat wave. Liz Merah, a spokeswoman for the governor, said the department will be convening a number of agencies, including the Oregon Department of Human Services, Oregon State Police, Oregon Health Authority, and Oregon Housing and Community Services, to review actions taken and determine where improvements can be made. The agency will also summon counties, nonprofits and community-based organizations for input on how the state can help them better prepare and respond, she said. At least 83 people have died statewide from confirmed cases of hyperthermia while 32 deaths remain under investigation and are suspected of being heat-related. Meanwhile, Multnomah County Chair Deborah Kafoury has directed an after-action report report, as well, to focus on the countys efforts and staffing in response to the heat wave. Officials have not provided a date for when the review will be complete but plan to update their incident playbook to more effectively react to extreme heat in the future. Given the unmatched death toll, the county review seemingly will seek to answer difficult questions. But such after-action reviews can often be a space for confusing or vague suggestive corrective actions and personal recommendations, officials have previously noted, encouraging a more rigorous root-cause analysis that clearly defines a problem and seeks to answer how it happened by asking why five times in search of the answer. Voss said all the deaths caused by the latest heat wave were preventable, but designing an emergency response to fully eliminate fatalities is difficult. Much of it relies on better communications, he said, so the countys message is better received by the public and more people take advantage of the available services. There is an operational component that we need to manage, but how do you get to the person who is so fiercely independent that they were not willing to tell family members what their real situation is? he said, citing an example of one man who died in Washington County after falsely telling his daughter he had three air conditioners. Its hard to get to the point where we can reach that person and get them the help they need. The person most likely to help you is probably your neighbor, and that has to be part of the equation, the community helping each other, he added. But during the event, if youre knocking on your neighbors door for the first time, its almost too late.   Ted Sickinger; tsickinger@oregonian.com; 503-221-8505; @tedsickinger