Medical Care

MEDICAL CARE Medical care and evacuations effectively treated a massive and overwhelming evacuee population. Federalized teams of medical fi rst responders suffered from a lack of advance were deployed to the affected region to provide assistance. preparations, inadequate Millions of dollars worth of medical supplies and assets communications, and diffi culties were consumed. Some Department of Health and Human coordinating efforts Services (HHS) assets, like the Federal Medical Shelters, had never been used or tested prior to Katrina but were deployed and were, for the most part, considered effective. Summary Despite diffi culties, the medical assistance and response to Hurricane Katrina was a success. Thousands Public health preparedness and medical of lives were saved because of the hard work and enduring assistance are critical components to any disaster efforts of public health offi cials and medical volunteers. response plan Poor planning and preparedness, however, were also too big a part of the story, resulting in delays and shortages of Hurricane Katrina tested the nation’s planning and resources, and loss of life in the region. preparedness for a major public health threat and This chapter outlines what medical personnel and highlighted the importance of strong cooperation supplies were pre-positioned, and deployed post-landfall, and partnerships among health agencies at all levels to the affected area and how those assets were utilized. of government. The threat of any type of disaster It explains the plans in place prior to Hurricane Katrina emphasizes the need for planning and practice. Public for health care facilities and shelters. The fi ndings in this health preparedness and medical assistance are critical chapter conclude several defi ciencies in public health and components to any disaster response plan — the faster medical response plans exist at all levels of government the health community responds, the more quickly control and within medical care facilities. Ultimately, better strategies can be developed and appropriate treatments can planning and initiative would have resulted in a more be identifi ed. And the faster human suffering is diminished. proactive, coordinated, effi cient, and effective response. The annual hurricane season is a continuous challenge to public health infrastructures and a strain on Personnel resources. As seen in the preparation for and response to Katrina, medical personnel, supplies, and equipment HHS and the Department of Homeland Security (DHS) were in constant need in the Gulf coast region. Despite have the capabilities to mobilize and deploy teams of defi ciencies in coordination, communication, and medical personnel to disaster areas. HHS controls the capacity, public health and medical support services Public Health Service Commissioned Corps, the Medical Reserves Corps, and personnel from its agencies such as the Centers for Disease Control and Prevention (CDC), National Institutes of Health, Substance Abuse and Mental Health Services Administration, and the Food and Drug Administration. DHS, specifi cally FEMA, has direct control over the National Disaster Medical System (NDMS), which supplies and organizes teams of medical personnel in each state who stand ready to deploy at any moment. Unfortunately, limited numbers of personnel were pre-positioned prior to landfall, and most deployments were delayed until after the storm hit and the magnitude of devastation was realized. FEMA A FAILURE OF INITIATIVE 267 Supplies by Hurricane Katrina. Nor does it include every detail of the communications and coordination diffi culties which In addition to medical personnel, HHS, FEMA, and the impeded the medical response. Department of Defense (DOD) have medical supplies at Rather, this chapter provides fi ndings based on an their disposal to respond to a public health emergency. in-depth examination of specifi c plans in place before the HHS has control over the Strategic National Stockpile storm, and a timeline of events that actually took place (SNS), a national repository of pharmaceuticals and after the storm. Similarly, the Select Committee recognizes medical supplies. NDMS personnel teams are always this section of the report focuses on the evacuations of accompanied by large caches of supplies and drugs. DOD New Orleans medical facilities in particular. Because New has a mobile medical unit capability as well. Limited Orleans hospitals and facilities experienced the most amounts of supplies, however, were staged in the region complete failure of equipment and communications, prior to landfall. Several offi cials argued the magnitude and because the need to evacuate New Orleans hospital of the storm’s devastation could not have been predicted, patients was so extreme, the Select Committee chose these and the amount of supplies needed was unknown until institutions as its focal point. the fog cleared. Despite that argument, more supplies and personnel could have been pre-positioned prior to landfall. Evacuations As it stands, Louisiana hospitals and nursing homes are responsible for having and implementing their own emergency evacuation plans. The Louisiana Hospital Association (LHA) does not provide specifi c emergency response or evacuation guidance and said, with respect to protecting patients and staff, the primary priority for all hospitals is to “shelter in place” versus evacuate. Hospitals are, however, expected to comply with requirements set forth by the Joint Commission on Accreditation of Healthcare Organizations.2 The majority of hospital CEOs, as well as state and local medical personnel with whom the Select Committee met, cited time and money as two key factors infl uencing AP PHOTO/BILL HABER their decision about whether to evacuate patients from a shelter or medical facility prior to a hurricane. Time is Evacuation plans, communication, critical given that the majority of hospital and Department and coordination must be executed well of Veterans Affairs Medical Center (VAMC) plans call for for effective response evacuation decisions to be made anywhere from 36 to 72 hours in advance of a hurricane’s projected landfall During the days following Hurricane Katrina, around the — hospitalized patients require a signifi cant amount of clock media coverage of patients and staff trapped in New time and staff to be moved safely. In the case of Hurricane Orleans hospitals inundated television screens across the Katrina, the then Methodist Hospital CEO, Larry Graham, country. The nation watched in horror. How long would said when he realized Hurricane Katrina was going to it take for evacuations to begin? And why had these hit New Orleans, there simply was not enough time to hospitals not evacuated before the storm? evacuate patients. The Select Committee focused part of its medical The second much-discussed factor, cost, is perhaps investigation on these questions, as well as the even more critical to the decision. Expenses for evacuating overarching issues of impaired communications and lack a hospital are astronomical, and in the case of for-profi t of coordination. The Select Committee acknowledges this hospitals, these costs are not reimbursable by FEMA. In chapter does not tell the story of every hospital devastated 268 A FAILURE OF INITIATIVE Time is critical given that the majority of hospital and Department of Veterans Affairs Medical Center (VAMC) plans call for evacuation decisions to be made anywhere from 36 to 72 hours in advance of a hurricane’s projected landfall most cases hospitals say that given their cost/risk analyses, One of the most common and pervasive themes in it makes the most economic sense to ride out a storm and the response to Hurricane Katrina has been a systematic protect patients within the hospital rather than evacuate failure of communications at the local, state, and federal them. For example, going to Code Grey alone (without levels — a failure that hindered initiative. The accounts factoring in evacuation expenses), costs Louisiana State of New Orleans medical facilities and special needs University’s hospitals $600,000 per day.3 Many members shelters are no exception, underscoring how failed of the New Orleans medical community likewise made communications with the outside threatened the safety of the point, had Hurricane Katrina not resulted in such medical staff and the lives of their patients. It was diffi cult catastrophic fl ooding, their facilities would have been to ascertain a clear timeline of communication capabilities prepared, and their decision not to evacuate patients and failures for medical fi rst responders and personnel. would have been the most prudent course of action. With Institutions did not have time to collect information the factors of time and money in mind, this chapter seeks for hourly or even daily reports of how communication to understand evacuation plans in place prior to Katrina, equipment and systems were working or not. Medical and preparedness levels of hospitals and the government responders and personnel simply did not have adequate to fully evacuate New Orleans medical facilities. communications capabilities immediately following the hurricane. The majority of cell phones were rendered Communication and Coordination inoperable because they could not be recharged. Satellite communications were unreliable, and the distribution of Medical responders and coordinating offi cers from the satellite phones appeared insuffi cient. government, hospitals, and private entities, cited non- Government agencies also encountered

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