The Trauma Signature of Hurricane Sandy

By James Shultz and Yuval Neria

Two feet of snow blankets the trails of Snowshoe Mountain, West Virginia—on Halloween! Eight million mid-Atlantic residents lose electricity. Jamaica takes a direct hit from a newly minted Category 1 hurricane. A cyclone comes ashore south of Atlantic City, trapping coastal residents who ignored evacuation orders. Deluging rains saturate Haiti’s deforested terrain, triggering mudslides and killing 60 people. New York City subways sustain the worst flooding in the system’s 108-year history and seven East River tunnels fill with water. Tropical storm gusts and high surf whip the entire Atlantic coast of Florida as a hurricane sweeps over the Bahamas. A transformer explodes in Breezy Point and 111 units burn to the ground in a six-alarm conflagration fueled by gale-force winds.

These diverse events, compressed into the span of a single week, were all manifestations of one massive weather system that became known as “Superstorm Sandy.” Almost 70 million people across eight nations, 24 U.S. States, and Puerto Rico encountered the storm. Their experiences varied from a bad weather day to a catastrophic event.

Sandy was a meteorological chimera. For those in its path, the storm materialized as an entirely different animal, depending upon timing and locale.

How do we begin to make sense of the range of potential health effects of such a novel event?

We are actively exploring how the physical forces of harm in a disaster transform into both physical and psychological consequences for the disaster-affected population using an approach called trauma signature analysis, or TSIG.

TSIG provides a much-needed tool to expedite the provision of evidence-based, actionable guidance for a coordinated disaster health response. This process integrates disaster public health and disaster mental health. It is premised on the notion that each disaster leaves an imprint on the affected population. Understanding this distinctive “signature” can help prepare and protect responders and better serve survivors by tailoring response to the disaster’s defining features.

TSIG is epidemiological, examining the person, place, and time dimensions of exposure to natural and human-generated hazards during the impact phase of disaster, and to a variety of losses and changes in the aftermath.

The initial step of TSIG involves constructing a hazard profile of the disaster to delineate the types, magnitude, intensity, scope, and scale of exposures. This information can be rapidly gleaned from disaster situation reports released in real time as the event is unfolding, and from disaster monitoring and research centers.

The next step of TSIG involves assessing the potential psychological effects of the physical forces of harm characterized in the hazard profile. A stressor matrix is created, presenting the salient risk factors for psychological consequences within each of the disaster phases and this is cross-referenced with a review of the evidence-based literature. Finally, TSIG juxtaposes hazard, vulnerability, and resilience factors and provides a synopsis of findings in a TSIG summary.

For Sandy, the hazard profile is more complex than for most disaster events. Because disasters are experienced locally, individuals’ memories of Sandy will be compartmentalized by time, geography, and community. For tropical cyclone-savvy millions in Jamaica, Cuba, the Bahamas, and the Florida peninsula, Sandy was both predictable and unexceptional.

Sandy started out as a typical counter-clockwise spiral of thunderstorms in the southern Caribbean, creating a vortex and a healthy outflow before moving northward to collide with Jamaica, hurdle eastern Cuba, and batter the Bahamas. Sandy stayed offshore from the U.S., moving parallel to the Southeast coast. This trajectory is typical of storms in the waning weeks of the Atlantic Basin Hurricane season.  These storms almost always curve back into the Atlantic Ocean, chill over cold waters, and dissipate.

Not Sandy.

In the mid-latitudes, anomalous weather fundamentally altered the course of the storm. As Sandy moved northward, the polar Jet Stream that usually deflects storm systems into the Atlantic, developed an inward inflection, drawing Sandy inexorably toward the mid-Atlantic coast.

Approaching New Jersey, Sandy was reinvigorated with an infusion of cold energy that “spun the system from the top down,” according to James Franklin of the National Hurricane Center. While the storm retained extraordinary power, the forces became broadly diffused across the system’s rapidly expanding diameter rather than concentrated in the center.

Notable for its enormity, Sandy simultaneously slammed the New Jersey coast, pummeled New York City with record-setting surge waves at high tide, dumped two to three feet of wet snow on West Virginia’s Appalachians, and blasted the densely-populated Northeast with flooding rains amid strong gusts.

Given Sandy’s multifaceted nature, and multitude of presentations across a range of climatic conditions and topographies, the physical and psychological consequences of the destruction were widely dispersed and highly variable. In the U.S., enduring damage, destruction, and displacement were concentrated primarily in New Jersey’s Atlantic City area, the site of hurricane landfall, and in coastal portions of the New York City metro area that were inundated as the storm’s forward motion and counter-clockwise winds funneled waves into Long Island Sound and the New York Harbor.

A distinguishing feature for Sandy was the interplay between the natural elements of the storm system with the vulnerable human-built environment and fragile infrastructure that led to many of the harms and hardships experienced. Eight million people along the East Coast of the U.S. lost electrical power for prolonged periods, disrupting television, telephone, and Internet communication. Over 20,000 people were displaced from flood-ravaged homes. In New York City, tunnels and subways flooded. There were shortages of food and gasoline. And, a powerful Northeaster, Athena, created harsh winter weather conditions.

Perhaps the greatest unmet public health need is outside of the U.S., however. In Haiti, Sandy affected 1.5 million residents, creating a population displacement and food security crisis. Though Haiti received only mild tropical storm force winds, Sandy’s outer bands pelted barren hillsides with 20 inches of rain, setting off raging floods, destroying crops, and drowning livestock.

Fortunately, the death toll is modest for such a large-scale event (about 115 deaths in the U.S. and 200 deaths total). Sandy’s price tag is over $50 billion in the U.S., the second costliest hurricane in the nation’s history. This reflects pervasive but relatively mild damage for large numbers of citizens as well as severe losses in focal impact areas of prime real estate in New Jersey and New York City.

TSIG analysis of Sandy is the most recent in a series of case studies, such as those of Haiti and Japan, which apply this novel method to a spectrum of natural and human-generated disasters and humanitarian crises. The current stage of TSIG development deals with the creation of algorithms and protocols for translating post-impact, pre-deployment TSIG analysis into practical guidance for response. In 2013, an Internet-based Delphi Method with a group of nominated experts in disaster public health and disaster behavioral health will be conducted to refine and validate the process with the goal of having a fully operational tool by year’s end.

Despite the scope and scale of the storm, Sandy certainly will be remembered lifelong by millions, but as a wholly different creature depending on the vantage point and the geography of the beholder. Sandy’s signature is indeed unique, but it seems as though with climate change, the writing on the wall is clear. Anticipating the range of possibilities, enabled by an approach to disaster response with tools like TSIG, we can be better prepared for the aftermath of other disasters whose autographs we would rather not have.

Edited by Dana March.

This article originally appeared on, an online publication sponsored by the Department of Epidemiology at Columbia University. 2×2 aims to inform the health conversation through timely and effective communication of emerging public health science.