In the immediate aftermath of Hurricane Katrina, my colleagues and I sought to analyze the medical and public health response to the hurricane and resulting disaster in New Orleans. Our aim was to identify lessons and suggest improvements to federal, state, and local government and private sector healthcare preparedness efforts for the next disaster. Our paper, published in 2006, found that there were critical missing elements to this response which resulted in Systemic Collapse of medical and public health systems in New Orleans at the time.
Our analysis was informed by interviews with individuals who had on the ground experience with the medical and public health response to Katrina as well as a review of news reports, government documents, and other publications that touched on the medical and public health response. Our report identified 4 key findings and provided recommendations for improvement, which we’ve presented here (“Then”), in parallel with our analysis of the current state of play (“Now”).
Finding 1, Then: Federal, state, and local disaster plans did not include strategies or provisions to keep hospitals functioning during a large scale emergency.
- Hospitals either lacked sources of backup power, or had generators housed in basements, making them vulnerable to flooding.
- There were no backup communications equipment or communications plans in place.
- There was no regional or city-wide planning and coordination for the healthcare system response to a disaster.
Finding 1, Now: Since Katrina, the HHS Hospital Preparedness Program (HPP) has resulted in notable improvements to our healthcare preparedness. In particular, the formation of regional healthcare coalitions throughout the country has advanced regional planning, coordination, stockpiling, and communications capabilities. While coordination and communication can always be improved, it is clear that hospitals, public health agencies, other healthcare providers, and emergency management are more closely aligned and better at response than ever before. Most hospitals in Louisiana and other states now also have much better contingencies for essential hospital systems, although challenges remain, as seen during Superstorm Sandy, when flooded fuel pumps caused a loss of power at one hospital.
Finding 2, Then: The National Disaster Medical System was a valuable source of medical professionals. But as a whole, it did not function as a system and was ill-prepared to provide medical care to the thousands of patients who needed it.
- Poor logistics management resulted in reduced ability for Disaster Medical Assistance Teams (DMATs) to deploy in a timely way, and teams were often separated from their supplies.
- There were too many patients and too few NDMS personnel, who were the majority of medical responders. This resulted in NDMS only being able to provide basic triage and first aid.
Finding 2, Now: Since 2005, NDMS has deployed to other large and small disasters including tornados and the earthquake in Haiti. In general, it is still unclear how NDMS and its teams should and will be used for response. Should NDMS be highly specialized to provide advanced care, or should it be a first responder responsible for triage and basic treatment? Will it continue to be involved in international response, or is it solely a US asset? These and other questions still remain 10 years later.
Finding 3, Then: There was no coordinated system to recruit, deploy, and manage volunteers during the medical response to Hurricane Katrina.
- There was no federal office to coordinate this response.
- There was no way to register and verify credentials of medical volunteers in place.
- The Medical Reserve Corps was ready to provide assistance, but was not used to its full potential often due to legal and liability concerns.
Finding 3, Now: Hurricane Katrina prompted a number of improvements in this area. We now have a system in place to register and verify credentials of medical volunteers called the Emergency System for Advanced Registration of Volunteer Health Professionals (ESAR-VHP). Each state now has some version of this in place, although funding has been dramatically reduced in recent years. Progress has also been made in addressing legal and liability concerns; many states have reviewed and improved laws addressing VHP liability in disasters. Finally, the MRC has grown dramatically and matured in their approach to both everyday health threats and disasters.
Finding 4, Then: Hurricane Katrina separated many Gulf Coast residents from their medical records, leaving VHPs without medical histories to help guide patient care.
Finding 4, Now: We’ve come a long way since 2005 in the area of electronic medical records and personal health records. In 2009, only 11.9% of hospitals and 22.8% of office-based physicians had any kind of electronic medical record system. Now, over 95% of hospitals and 54% of office-based physicians in the US not only have electronic medical records, but have demonstrated meaningful use of those systems according to CMS requirements under the American Recovery and Reinvestment Act of 2009. Similarly, pharmacies across the US have also adopted electronic, redundant records systems. Challenges remain in interoperability between records systems, with public health agencies, and with laboratories, but great strides continue to be made in these areas.
Ten years later, the US has faced a number of other tests of our health system’s preparedness including tornado outbreaks in the Midwest, infectious disease emergencies like the H1N1 influenza pandemic and Ebola, and other extreme weather events, including Superstorm Sandy. While every disaster serves as a learning experience, and much work remains to be done, in the intervening years since Hurricane Katrina, we have witnessed demonstrable improvements in our ability to handle large disasters and maintain responsive, high functioning healthcare and public health systems, and we hope that trend continues.