Climate Hazard Risk in Those with SCI

Climate Hazard for those with SCI

(February, 2023) Miami is flat, snowless, has no state income tax, and is home to world-class academic medical centers—such as the University of Miami Miller School of Medicine, home of The Miami Project to Cure Paralysis—delivering and advancing paralysis research and care. Combined, these factors make the region a lighthouse for people with mobility impairment, exemplified by the fruitful and abundant community of people with spinal cord injury (SCI). However, juxtaposed to these enabling conditions are very real climate hazards in the form of hurricanes, heat, and flooding. The Miami Project’s David W. McMillan, Ph.D., a newly onboarded assistant professor, is partnering with various local experts to leverage the region’s unique climate position and point the best and brightest in this area toward the special case and unique needs of SCI.

Climate hazards are a risk to all life on Earth, but certain places and people are at disproportionate risk. Miami is certainly one such place, and those with SCI have specific and unique needs in the face of these hazards. Certain climate health risks in this population are outwardly self-evident, for example wheelchairs are mechanical vectors to liberty but only within the narrow constraints of the built environment they are designed to operate within. Wheelchairs of all types poorly traverse even the smallest obstacle, and power wheelchairs in particular are incongruent with water. But other risks are invisible and yet important in the context of climate and health. Neurogenic restrictive and obstructive respiratory function compromises breathing and worsens outcomes if lung infection sets in; the inability to sweat due to paralysis of blood vessels and sweat glands worsens risk of heat illness during the hot hurricane season; the fragile and highly consequential breakdown of paralyzed skin; bowel, bladder, and other self-care routines require a high throughput of consumable supplies; and so many others. Even at first glance the logistics are daunting, and upon further reflection the strategic considerations make the solution space seem as complex as the storms that pose the predicament in the first place.

For precisely these reasons is Dr. McMillan turning to the tool of research to wrangle an understanding from the problem space—and hopefully yield some actionable recommendations. In 2018, under the leadership of Dr. David R. Gater Jr., M.D., Ph.D., professor and chair of Department of Physical Medicine and Rehabilitation and Miami Project researcher, Dr. McMillan and a team of other Miami Project faculty, staff, and students began to investigate hurricane preparedness in the local SCI community. The investigation began due to sentiments shared with the team at a spinal cord injury support group meeting. Initial efforts included production of a SCI-specific hurricane preparedness resource packet, gathering local resources into a single document and modifying them for SCI-specific needs. A survey was also deployed, exploring broadly current state of the community’s situation to characterize knowledge, attitudes, and behaviors surrounding hurricane preparedness. The results of this survey show that knowledge of hurricane preparedness resources varies by resource location, with more knowledge about increasingly local services. People with SCI reported a relatively neutral attitude toward hurricanes in general and high confidence in their ability to respond. However, behaviorally they did not report the practices that would indicate successful resource utilization during times of need.

To understand the under-utilization of climate disaster resources, and also scale the approach to adjacent climate hazards such as heat and flooding, Dr. McMillan applied for and was awarded a University of Miami Laboratory of Integrative Knowledge (U-LINK) Resilience Challenge award titled Using community-engaged research to launch climate change resilience from an inclusive design beachhead starting with Southeastern Floridians living with spinal cord injury (SCI). “This project, now in official partnership with the very SCI support groups that spurred the initial investigation, takes advantage of our Rosenstiel School’s concentration of climate scholars,” say Dr. McMillan. “My aim is simply to take advantage of our institution’s amazing climate affordances by putting these authorities in the room with people with SCI and honing their expertise onto this population.”

The project includes three other faculty to achieve these ends: Dr. Katharine J. Mach, Ph.D., professor for Rosenstiel School of Marine and Atmospheric Science and faculty scholar at the Abess Center for Ecosystem Science and Policy, Joanna Lombard, A.I.A., L.E.E.D. A.P., professor of Architecture and Public Health, and Trevor Green, senior lecturer of Journalism and Media Management. Dr. Mach, lead author of a chapter of the Intergovernmental Panel on Climate Change (IPCC) Sixth Assessment Report, shares her experiences on the project so far. “This collaboration has been a profound and powerful experience. My expertise is in adaptation science – understanding how people and societies are preparing for the changing climate and its novel threats and also supporting ongoing decision-making. People living with SCI experience unique and elevated risks, whether from heat, hurricanes, or flooding. Solutions already being implemented point to both innovations and needs relevant in the future. And what’s exciting is that the insights from this collaboration also reverberate much more broadly, as we work to create an inclusive, supportive community and built environment that is easy to navigate, safe, and vibrant in both the near and long term.”

Updates to the project begins with translation of the resource packet into a website, and a series of workshops to spread knowledge about resources. These communication efforts go under the name Subtropical & Tropical Climate Health (STiCHH), and are in official partnership with National Oceanic and Atmospheric Administration (NOAA) as an approved Weather-Ready Nation Ambassador™ site. There is also an expansion of the research approach to distil the community’s experiences into rich, contextual qualitative data that can provide a framework for moving forward. Finally, the grant includes official government partners in the workshops and research to augment the implementation of the findings.

“As a lighthouse, it is our responsibility to help our unique community face their unique climate risk,” say Dr. McMillan. “In rising this this resilience challenge, this ULINK affords the opportunity to unite experts from all three campuses—Main, Med, and Marine—to explore needs and generate hypotheses for future solutions that if applied to this community will scale for the benefit of all.”