Health Policy and Management

1

Hurricane Katrina

Ms. Megan Shrum, BA

Health Policy and Management

MPH 525

Megan Shrum

April 2013

Table of Contents

Chapter Page

1. Introduction...... 2

Effects of Hurricane Katrina...... 2

2. Collaboration...... 3

Problems Involved with the Response to Katrina...... 7

Challenges...... 9

3. Federal, State, and Local Policies...... 7-8

4. Conclusion...... 10

Summary...... 11

Recommendations...... 12

References...... 15

Chapter 1

Introduction

Effects of Hurricane Katrina

In 2005, a total of 15 tropical storms became hurricanes. Each was known for its high wind speeds and intensity.On August 29th of 2005, a hurricane struck the Gulf Coast regionnearly destroying all of New Orleans. America found itself unprepared for the catastrophic event that was sweeping away the land of Louisiana. The unprecedented natural disaster destroyed thousands of homes taking many lives and leaving our country in a state of panic. Americans watched in desperation, wondering what they could do to help. Public health agencies all around the world took action and sought answers for what went wrong, hoping to better prepare themselves for a future disaster.

After a series of events Katrina became the deadliest hurricane to ever strike in the U.S. since 1928. The devastating storm struck the land of Louisiana, Mississippi, Alabama, and Florida with heavy winds, rain, and a storm surge that caused so much devastation to the land. The ferocious storm broke the levee system surrounding New Orleans causing a devastating flood that filled 80% of the city. The storm surge was reported to be 27 feet high extending inland for 6-12 miles with a measured wind speed that got up to 132mph. Extreme flooding filled the land of Biloxi and Gulfport, destroying nearly 80% of buildings in Waveland. The high wind speed and strong storm surge arguably made Katrina the costliest natural disaster to hit the U.S.Thousands of people were left without shelter, food, clothing, water, utilities, and access to healthcare. The counties of Hancock, Harrison, and Jackson suffered the greatest devastation with electric power, communications networks, roads, sanitation systems, and water treatment plans being destroyed. In Hancock, 21.5% of the homes had no running water, 40% had no electricity, 37% had no working toilet, 50% had no working telephone, 26% had no access to transportation, 33% had no trash disposal, and 10% had no access to news. Many hospitals, health clinics, and public health facilities were either not functioning at all or not functioning properly, leaving the communities with very little healthcare during a time of dire need (CDC, 2006).

A reported nine hundred and seventy one deaths were claimed in Louisiana alone and fifteen evacuee deaths that occurred in other states. Of the nine hundred and seventy one deaths, 387 victims drowned, 246 died from trauma or injuries, and the other deaths related to hurricane Katrina were unspecified (Brunkard, Namulanda, Ratard, 2008). A total of thirteen hundred lives were taken due to the hurricane while two million people were displaced from their homes. The hurricane also caused three hundred thousand homes to be destroyed, resulting in almost $100 billion in property damage (Teitelbaum, Wilensky, 2013). A disaster of this magnitude calls out local, state, and federal leaders as well as sheltering organization, and health professionals in order to help save lives and minimize damage. It is reasonable to believe that as all these personalities, beliefs, and ideas come together during a major disaster, disagreements and arguments will brew. Such was the case during the response to Hurricane Katrina.

Chapter 2

Collaboration

On August 30th, media informed the world about the horrific events that were taking place in New Orleans due to Hurricane Katrina. Reports explained that thousands were trapped in the city, some in buildings surrounded by water, others on rooftops, and some who sought refuge in the Superdome and the New Orleans Convention Center. Many were without access to TVs, phones or internet, and therefore communication was very challenging (Mattox, 2005). By August 31st, the Governor of Louisiana and Texas began communicating with the County Judge of Harris County, and the Mayor of Houston, Texas, about how to move evacuees from the Superdome to the Astrodome. Local organizations as well as 35 people from state, county, and city agencies met to design the plan. Six groups were designated to logistics, operations, contributions, volunteers, placement and employment, and medical. Each group knew what their assignment was and began to develop a strategy of implementation.

The medical group was made up of four physicians and two administrators, whose goals were to screen evacuees as they arrived, they also provide an area at each sleep area which can contain up to 25,000 persons, they inspect food, establish an accessible clinic, electronic medical record, laboratory, pharmacy, radiology, and specialty medicines. On top of their other duties the medical group provided a significant amount of support for mental health, special needs patients, and surveillance for infectious diseases. The team was able to predict how much and what type of medical, social, mental health and related conditions as well as how much space and personnel would be required in order to complete each goal. Overall the planning took four to six hours while the clinic was put in place within 12 hours. In order to accomplish their goals, the medical group collaborated with the Baylor College of Medicine, community physicians of Harris County Medical Society, and the networks of the Harris County Hospital District. The clinic would pass on patients who had conditions that they were unable to treat or care for, to the area hospitals. As well as planning out how the clinic would function and operate, it also was necessary for them to design an exit strategy. Their plan was to keep the clinic open only two weeks or until the Reliant AstroCity population reach 3000. The goal was to have all evacuees in a more permanent setting within 17 days. This goal was shared with the media and all other collaborating partners. Evacuees were informed by the clinic that their goal was to provide them with education, housing, and job opportunities in order to jumpstart their new lives. Evacuees then became a part of the exit strategy. The medical group would implement these strategies and also were responsible for communicating with the local, regional, and national agencies about their timeline, implementation, also with medical professionals, the press, the public, and evacuees. One member of the medical group would stand at the podium at each press conference, sharing the information. The disaster, emergency medicine, surgical, critical care, and trauma Internet websites were also used to alert international readers about the progress of the program. These activities were successful in alerting the press and the community about what to expect medically (Mattox, 2005).

Due to a vast majority of communication lines being severed, the Mississippi Department of Health (MDH) asked the CDC to help provide active surveillance at EDs, federal Disaster Medical Assistance Team operation sites, and outpatient health care facilities in Hancock, Harrison, and Jackson Counties. The CDC sent 17 staff members to work with the MDH and the Epi Strike Team from Florida’s Department of Health. Through their collaboration, they were able to provide surveillance of injuries and illnesses that occurred due to the hurricane. Daily reports were provided to the MDH about outbreaks and data that would help to direct public health’s focus in the affected area.

Due to the gravity of Hurricane Katrina, essentially all areas of the HHS responded with assistance and guidance to survivors and their families. The CDC used the Strategic National Stock Pile (SNS) in order to distribute drugs and other medical supplies, while at the same time integrating public health and occupational health guidance. The FDA provided recommendations on what to do with potentially damaged drugs. The NIH got involved by setting up a phone based medical consultation service that would be used by providers throughout the region. Mental health concerns were very prevalent in the wake of Hurricane Katrina, as a result the Substance Abuse and Mental Health Services Administration designed/provided counseling services for victims and their families as well as providing emergency response grants. Another major group who assisted in the relief of Hurricane Katrina was the National Disaster Medical System. This group provided fifty Disaster Medical Assistance and Teams in an effort to accommodate and service victims. The Disaster Mortuary Capital Response Teams aided in processing the bodies of the victims from the storm. The New Orleans International Airport housed field hospitals that were setup by the Department of Defense. In order to accommodate the vast number of victims, the Department of Veteran Affairs provided care and shelter in both of their hospitals (Teitelbaum, Wilensky, 2013). Also, many who were left stranded and surrounded by water waited for responders to rescue them. Although the process was long and daunting for those stranded, many said they were rescued by the Coast Guard, National Guard, or the military. Others reported that they were rescued by friends or civilians (Brodie, Weltzien, Altman, Blendon, Benson, 2006).

The Federal Emergency Management Agency is a national organization that’s mission is to, “support our citizens and first responders to ensure that as a nation we work together to build, sustain, and improve our capability to prepare for, protect against, respond to, recover from, and mitigate all hazards” (FEMA, pg. 1, 2013). FEMA collaborated with any national, state, and local responders. They worked with private and public institutions to aid in the relief of Hurricane Katrina. FEMA provided search and rescue as well as shelter for stranded individuals. They were to communicate with the state of Louisiana and mesh both of their command structures (Ahlers, 2006).

Problems Involved with the Response to Katrina

Hurricane Katrina was the worst natural disaster in recent history that really opened our eyes to improvements needed within our emergency preparedness structures. The consequences of Hurricane Katrina were exacerbated by the faulty levee system designed by the U.S. Army Corps of Engineers. The lack of preparedness and response to the disaster by all levels of the government were brought to light as devastation struck the land of Louisiana. The population and both public and private sectors were warned far in advance about the potential hurricane, yet the warning was disregarded by many. It was fairly clear that Hurricane Katrina would strike this region and yet local and state officials failed to properly prepare, even after running through related scenarios and exercises. Local and state officials were unable to evacuate all of the citizens, struggled with logistics, and were unprepared for dealing with any vulnerable populations such as nursing home residents. However, local and state officials weren’t the only ones at fault, the federal government also failed to properly anticipate and prepare for the needs of the state and local authorities. The lack of coordination resulted in a lack of resources and a too-slow response (Teitelbaum, Wilensky, 2013).

A study was done using the evacuees staying in the Houston shelters revealing that only 49% of the evacuees said that in the days before the hurricane, they had heard the order to evacuate the city and that the order was clear and provided clear instructions about how to leave. Thirty-eight percent said they had evacuated ahead of the storm while 61% said they had not. Those who did not evacuate, which was nearly one third, reported that they had not heard an evacuation order. About three in ten said they had heard about an evacuation order but that it did not provide clear information about how to evacuate. Over one third sated that they had received clear information but chose to not evacuate (Brodie, et al., 2006). These studies show that the evacuation communication was poorly distributed and needs improvements.

When evacuees were asked which organization helped them out the most during the flood, most said the National Guard, the military, or the Coast Guard. Nineteen percent of the evacuees said that a private organization such as the Red Cross was very helpful. However, very few said police or firefighters. Only eleven percent reported that federal agencies such as the Federal Emergency Management Agency or the Department of Homeland Security had provided the most help. Nearly four in ten reported that none of these organizations had helped them (Brodie, et al., 2006).

The majority of the victims of Hurricane Katrina (76%) reported that they felt that the government’s response to the hurricane “was too slow, and there’s no excuse,” while 17% said that the time required for the government to respond “was reasonable under the circumstances.” The majority of evacuees were unhappy with the job government leader’s federal, state, and local did in handling the hurricane. The lives of those who did not evacuate depended on the quick response and deployment of search and rescue teams in helicopters and boats, yet the response was slow leaving many stranded individuals without protection. Also the arrival of emergency medical service personnel, food and water was vital to limiting the devastation. Preexisting plans were set, yet many personnel and resources didn’t arrive until one week after the hurricane. This greatly increased the amount of devastation, spread of disease, and the number of deaths that could have been prevented.

FEMA was greatly criticized for their performance in the relief of Hurricane Katrina. They were to communicate with the state of Louisiana and mesh both of their command structures. However this did not go over well, Louisiana and FEMA struggled to achieve a unified command system with FEMA. It wasn’t till three days after the hurricane that FEMA truly got involved. FEMA has stated for a long time that state and local governments should be prepared to survive 72 hours before federal intervention. However, this is not widely accepted by many state and local officials as well as community members. Many did not feel that FEMA was meeting their expectations or providing effective and efficient relief to the communities. Emergency housing was provided to slowly and there was not an adequate amount of housing, search and rescue was slow and late to respond, and they also struggled to track their supplies. Very few collaborating organizations had confidence or trust in the FEMA system. This stalled the process of relief to victims of Hurricane Katrina.

Challenges

Studies which focused on previous disasters show that in the case of any given storm, a portion of the populations will choose to reside in their homes instead of evacuating. Therefore, there always is a portion of people who will require rescue and care afterwards (Brodie, et al., 2006). This creates many challenges for responders. Now, not only do agencies need to clean up the damage that has been done to the properties but also to provide care and resources to people who stuck around. This requires a lot of organization and early preparation in order to respond efficiently and effectively.

State and local officials are challenged to come up with an effective method to communicate with community members about a potential disaster and the importance of evacuation. It is difficult to effectively warn large populations who do not perceive the disaster with direct danger and it is then especially hard to convince them to evacuate. Those who are minorities, or come from lower-income households and those with elderly or disabled people are less likely to evacuate. State and local officials will have the challenge of reaching out to those populations and finding an effective way to warn them of the danger and the urgency to evacuate. This isn’t always easy when many community members are untrusting of government officials. Research also shows that those who have lived in an area for a short amount of time and lack experience with hurricanes tend to underestimate the danger or threat of the storm. However, the longer people have lived in the area, the less likely it is for them to evacuate (Brodie, et al., 2006). This may be because they have experienced previous storms that did very little to no harm to them. It is always challenging to convince people to leave their homes and properties.

Chapter 3

Federal, State, and Local Policies

With the growing concern over domestic safety, the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 are detrimental to our countries safety. This policy created a strategic national stockpile of medical countermeasures which would be vital in the response of a bioterrorist attack. The Drinking Water and Safety Security Title is imperative because it requires that communities do a full assessment of the vulnerabilities of the water supply (Teitelbaum, Wilensky, 2013). In a world where bioterrorism is a top threat and a growing concern, policy development that will prepare us for a disaster of the like is vital to our countries success and overall safety. The scares of 911 (anthrax) and smallpox have truly opened our eyes to the threat of bioterrorist attacks and the potential it could have if it ever reached the water supply. As a country we must continue to develop and implement policies like this to protect our country and the people in it.