Written By: Cecile C. Guin, Linda C. Robinson, Ezra C. Boyd and Marc L. Levitan Louisiana State University Table of Contents Author’s Note..............................................................3 Chapter 4......................................................................43 i. Findings and Recommendations Hurricane Katrina: Health Outcomes and the from Selected Official Documents Purpose of the Project.............................................5 Medical Response Chapter 7......................................................................81 Chapter 1.......................................................................7 a. Direct Morbidity and Mortality b. Displacement from Home, Comparison of Hurricanes Gustav and Ike to Overview of Disasters and Effects Hurricanes Katrina and Rita on the Medical Community Social Network, Providers and Medical History a. Overview a. Introduction c. Disruption of Medical Services b. Major Problems Affecting the b. Natural Disasters and the d. Emergent Effects of Exposure Medical Community during Vulnerability of the Health Care to Hazards Katrina and Rita Sector e. Medical Response c. Post-Katrina and Rita changes c . Hazard Types and the Associated f. Initial Response to Public Health that were Made for Gustav and Impacts Emergency Ike d. Effects of Disasters on Health Care g. Exemplary Medical Service d. Examples of Leadership and e. Disaster Frequencies and Impacts Organizational Effectiveness in Chapter 5......................................................................57 Gustav and Ike Chapter 2......................................................................17 Hurricane Rita: Preparation, Impact and Anticipating Potential Disasters Response of the Medical Community Chapter 8......................................................................97 Across the United States a. Physical Hazards and the Lessons Learned and Best Practice a. High Fatality Events Vulnerability of Southwest Recommendations b. Deadly Hurricanes Since 1950 Louisiana a. Overview c. The 1993 Blizzard and the 1995 b. Population of Southwestern b. Communication Chicago Heat Wave Louisiana c. Transportation d. Multi-Billion Dollar Events c. Physical Impact d. Sanitation e. Potential Disasters d. Impact on the General Population e. Consumables and Supplies f. Assessing Preparedness for e. Medical Response f. Utilities Potential Disasters f. Health Outcomes g. Specific Medically Related Concerns Chapter 3......................................................................29 Chapter 6......................................................................67 Hurricane Katrina: Preparation for and Impact Summary of Reports and Official Records on Appendices: ............................................................106 on the Medical Community Hurricanes Katrina and Rita a. Physical Hazards and the a. General Findings 1. Morbidity and Mortality Outcomes Vulnerability of New Orleans b. Transportation from Hurricane Katrina.....................................107 b. Planning for Catastrophe c. Communication c. Hurricane Katrina’s Physical d. Sanitation 2. References...............................................................110 Hazards e. Consumables 3. Photo and Figure Credits..................................119 d. Impact on the General Population f. Utilities e. Impact on the Medical g. Medical Records 4. Interview Reference List.....................................121 Community h. Barriers to Physician Efforts to Assist Author’s Note Cecile C. Guin, School of Social Work, Of- We would like to acknowledge the assistance ent in an easily read format, we have in- fice of Social Service Research and Develop- of Terri C. Michel, OSSRD, for project cluded an extensive reference list at the end ment (OSSRD), Louisiana State University; management and final document prepara- of the project providing credit to the many Linda C. Robinson, Family and Consumer tion; Vicky Tiller, OSSRD, for creating the authors of material that we used, as opposed Sciences, Louisiana State University Agri- survey, coordinating the survey dissemina- to the traditional academic in-text citation. culture Center; Ezra C. Boyd, LSU Hurri- tion, and editing; Mary Lynn Thames, There is some in-text citation that was nec- cane Center, Louisiana State University; LSUHSC, for invaluable input and editorial essary, but the majority of citations are in- Marc L. Levitan, LSU Hurricane Center, assistance; Nedra Davis, LSU Hurricane cluded at the end of this report. Louisiana State University. Center, Louisiana State University, for preparation of the Power Point training ma- Finally, we are appreciative to the Louisiana Contributing authors include: Emily DiSte- terial; Paul Watts, OSSRD, for the litera- State Medical Society Educational & Re- fano, DiStefano & Associates, Baton Rouge, ture review and editing; Ivor van Heerden, search Foundation for selecting us for this Louisiana; Justin Ulrich, School of Social LSU Hurricane Center, for input on the im- project, especially all of the physicians, local Work, Office of Social Service Research and pact of Hurricanes Katrina and Rita; S. medical societies, and others in the medical Development, Louisiana State University Ahmet Binselam, LSU Hurricane Center, field that contributed to this project by co- for cartographic support; Daniel Novak, ordinating or participating in the personal James H. Diaz, LSUHSC School of Public LSU English Department, for technical re- interviews, focus groups, and surveys. We es- Health, Louisiana State University Health view; Ra’Quel Shavers and Rakinzie Fisher, pecially thank the physicians who so gra- Sciences Center School of Medicine in New OSSRD, for the literature review and assist- ciously gave their time to tell their personal Orleans served as the medical consultant for ing with the focus groups; Marion Loyd, stories about Hurricanes Katrina and Rita, the project. Wanda Azema-Watts, and Dustin Drewes, and the LSMS staff including Dave Tarver, OSSRD, for general office support. Jeff Williams, Amy Phillips and Sadie Wilks. This project was funded by the Louisiana State Medical Society Educational and Re- In addition, the authors acknowledge the Correspondence concerning the project search Foundation through a grant from the important contribution of content gathered should be addressed to Sadie D. Wilks, De- Physicians Foundation for Health Systems from all of the published reports, articles, partment of Public Affairs, Louisiana State Excellence. news reports, and official documents upon Medical Society, 6767 Perkins Road, Suite which we have partially relied. Because the 100, Baton Rouge, Louisiana 70808. Email: funding body desired that the report pres- [email protected]. Phone: (225) 763.8500. www.healthcaredisasterplanning.org 3 Purpose of the PROJECT his project was undertaken to share many of the same principles and practices in pened in Louisiana and it can happen any- the experiences of the Louisiana order to avoid the worst case scenarios. This where. To protect their patients and their Tmedical community during and after report communicates to other medical com- practices, all physicians should take note of Hurricanes Katrina and Rita in hopes that munities through the words of physicians, the mistakes made and lessons learned in other regions can be better prepared to deal health care providers and administrators Louisiana. with the short term and long range impact who have shared their “lessons learned” in of a major disaster. Three and one half years detailed and informative accounts. This The Louisiana State Medical Society Educa- post disaster, south Louisiana and the other work has been expanded by the research of tional and Research Foundation (LSMS impacted Gulf Coast states continue their the LSU Hurricane Center, through collec- ERF) has undertaken this project to docu- struggle to recover from the storms and re- tion of information showing the real threat ment lessons learned in the aftermath of store the health care infrastructure that was of additional disasters across the nation – major hurricanes in 2005 and 2008. The literally washed away. Perhaps no profes- disasters for which many communities are project documents the major breakdowns sional community suffered greater impact unprepared. and failures of emergency preparedness plans from the storms than the medical commu- and emergency responses related to health nity. Hospitals, medical facilities, and many Prior to Hurricanes Katrina and Rita, the care in an effort to persuade physicians and medical practices were changed forever or Louisiana health care community was un- the health care community to reassess their completely lost. This report attempts to pro- aware of the myriad of problems that could emergency preparedness plans. The Physi- vide insight to what can happen to a medical be encountered in meeting patient health cians Foundation for Health Systems Excel- community when a catastrophic event takes care needs during and after a large-scale dis- lence (PFHSE) funded this project because place. The information is presented through aster. The ability of a physician to render, or of its belief that Louisiana is in an unfortu- empirical literature and, most importantly, the ability of a patient to receive, appropri- nate but unique position to share lessons through the experiences of medical profes- ate healthcare was fragmented or destroyed learned from a major disaster with other sionals who worked on the front lines during by the disaster. This fragmentation greatly states. The primary