Colonization with multidrug-resistant organisms in evacuees after Hurricane Katrina.

After Hurricane Katrina, 50 patients were evacuated to Grady Memorial Hospital in Atlanta, Georgia, with limited medical records. The infection control department ordered contact precautions for 16 patients. Surveillance cultures performed on admission identified colonization with multidrug-resistant (MDR) bacteria in 9 patients (18%). Presence of a wound was the strongest predictor for MDR colonization. More data are needed to reliably predict MDR bacterial colonization.     

Chronic disease and disasters medication demands of Hurricane Katrina evacuees

BACKGROUND: Preparing for natural disasters has historically focused on treatment for acute injuries, environmental exposures, and infectious diseases. Many disaster survivors also have existing chronic illness, which may be worsened by post-disaster conditions. The relationship between actual medication demands and medical relief pharmaceutical supplies was assessed in a population of 18,000 evacuees relocated to San Antonio TX after Hurricane Katrina struck the Gulf Coast in August 2005. METHODS: Healthcare encounters from day 4 to day 31 after landfall were monitored using a syndromic surveillance system based on patient chief complaint. Medication-dispensing records were collected from federal disaster relief teams and local retail pharmacies serving evacuees. Medications dispensed to evacuees during this period were quantified into defined daily doses and classified as acute or chronic, based on their primary indications. RESULTS: Of 4,229 categorized healthcare encounters, 634 (15%) were for care of chronic medical conditions. Sixty-eight percent of all medications dispensed to evacuees were for treatment of chronic diseases. Cardiovascular medications (39%) were most commonly dispensed to evacuees. Thirty-eight percent of medication doses dispensed by federal relief teams were for chronic care, compared to 73% of doses dispensed by retail pharmacies. Federal disaster relief teams supplied 9% of all chronic care medicines dispensed. CONCLUSIONS: A substantial demand for drugs used to treat chronic medical conditions was identified among San Antonio evacuees, as was a reliance on retail pharmacy supplies to meet this demand. Medical relief pharmacy supplies did not consistently reflect the actual demands of evacuees.     

Caring for a surge of Hurricane Katrina evacuees in primary care clinics

Primary care physicians are rarely mentioned in medical disaster plans. We describe how a group of mostly family physicians and administrators of the JPS Health Network (JPS) took primary responsibility for 3,700 evacuees of Hurricane Katrina who came to Tarrant County, Texas. JPS provided medical care to 1,664 (45%) evacuees during a 2-week period. The most common needs were medications for chronic illnesses and treatment of skin infections (primarily on the feet). The JPS Emergency Department saw only 148 evacuees, most of whom arrived by their own transportation and were not seriously ill. JPS created a triage center located several miles from the hospital that referred almost all evacuees with health care needs to a primary care clinic. It was an effective approach for caring for the medical needs of disaster victims and prevented an emergency department and hospital from being overwhelmed. The JPS experience may guide future planning efforts for natural or manmade disasters, especially pandemic threats.     

Medical response to hurricanes Katrina and Rita: local public health preparedness in action.

Like more than 150 communities in Texas, our community participated in disaster response for Gulf coast citizens evacuated from hurricanes Katrina and Rita. We implemented and adjusted emergency operations plans that were designed to respond to a local disaster. Lessons learned will strengthen our disaster preparedness in the future, including the importance of a robust medical presence at evacuation shelters; the value of an accurate and timely database of medical needs for shelter occupants; the usefulness of brief paperwork; the need for a preidentified and pretrained group of healthcare workers; the necessity of timely and accurate communications with medical partners in the community; the requirement that our local city government plan, open, and operate disaster shelters in our community; and the impact of ease of travel, frequent and honest communication, and sincere appreciation on maintaining morale in our volunteers.     

Providing shelter to nursing home evacuees in disasters: lessons from Hurricane Katrina

Objectives. We examined nursing home preparedness needs by studying the experiences of nursing homes that sheltered evacuees from Hurricane Katrina.Methods. Five weeks after Hurricane Katrina, and again 15 weeks later, we conducted interviews with administrators of 14 nursing homes that sheltered 458 evacuees in 4 states. Nine weeks after Katrina, we conducted site visits to 4 nursing homes and interviewed 4 administrators and 38 staff members. We used grounded theory analysis to identify major themes and thematic analysis to organize content.Results. Although most sheltering facilities were well prepared for emergency triage and treatment, we identified some major preparedness shortcomings. Nursing homes were not included in community planning or recognized as community health care resources. Supplies and medications were inadequate, and there was insufficient communication and information about evacuees provided by evacuating nursing homes to sheltering nursing homes. Residents and staff had notable mental health–related needs after 5 months, and maintaining adequate staffing was a challenge.Conclusions. Nursing homes should develop and practice procedures to shelter and provide long-term access to mental health services following a disaster. Nursing homes should be integrated into community disaster planning and be classified in an emergency priority category similar to hospitals.During and after disasters, the adequacy of response by public health agencies, medical providers, and public safety officials is influenced by the degree to which planning has addressed needs of special populations, such as vulnerable older people.1^–7 Previous research has found that nursing homes received notably less support than did hospitals from federal, state, and local response agencies during and after disasters.1^,2 Nearly 2 million Americans reside in about 18000 nursing homes.8 In the coming decades, nursing homes will care for many more frail older people with increasingly complex health needs.7^,9^,10 The disaster following Hurricane Katrina further demonstrated that our nation’s disaster management system does not respond adequately to the needs of frail older persons in nursing homes. About 70 nursing home residents died in 13 nursing homes during the immediate aftermath of Katrina.11 In addition to hurricanes, nursing homes are vulnerable to earthquakes, tornados, chemical spills from train accidents, and widespread lasting power outages caused by ice storms. The public health system and nursing homes need to incorporate the special needs of older populations into disaster planning, training, and education.1^–7^,9^,12^–14We present experiences and perspectives of administrators and staff at nursing homes in the Gulf Coast region that sheltered evacuees from Hurricane Katrina’s path. Such facilities are often called “sheltering” nursing homes. From their experiences, we sought to identify needs for preparedness training in nursing homes that may shelter evacuees from disaster areas and related practice and policy needs of the public health system.     

Displacement of the underserved: medical needs of Hurricane Katrina evacuees in West Virginia

On August 29, 2005 Hurricane Katrina struck Louisiana, Mississippi, and Alabama. During the aftermath of the storm, hurricane victims were evacuated to over 1,000 evacuation centers in 27 states. Three-hundred and twenty-three evacuees from 220 households were provided housing, food, and medical care at an evacuation center in West Virginia. A needs assessment followed to identify current needs of the evacuees. One-hundred and sixty-four evacuees were interviewed. Twenty-five percent reported an acute illness, while 46% reported having at least one chronic medical condition. The greatest need reported was for dental care (57%), followed by eyeglasses (34%), dentures (28%), and medical services (25%). Two weeks after the hurricane, the basic needs of food, shelter, and hygiene were met. The assessment identified and led to a successful response regarding the ongoing need for durable medical equipment (dentures and eyeglasses), as well as dental care.     

Learning from Katrina: environmental health observations from the SWCPHP response team in Houston

Hurricane Katrina provided an opportunity to observe the public health and medical care response system in practice and provided vital lessons about identifying and learning critical response measures as well as about ineffective investments of time and effort. The Southwest Center for Public Health Preparedness (SWCPHP) response team, while working among evacuees housed at Reliant Park in Houston, Texas, made a number of observations related to environmental public health. This summary reports firsthand observations which are, to a great extent, supported by the Federal Response to Hurricane Katrina: Lessons Learned report, and it provides a contextual backdrop for improvement in the areas of volunteer and citizen preparedness training and education. Katrina provided an opportunity to see public health in a highly stressed practice setting and to identify and reinforce the fundamental tenets of public health with which all individuals responding to an event should be familiar. Knowledge gained from Katrina should be integrated into future efforts related to disaster response planning; specifically, it is imperative that volunteers receive standardized training in the areas of incident command systems (ICS), basic hygiene, transmission of disease, and food and water safety principles.     

After Hurricanes Katrina and Rita: gender differences in health and religiosity in middle-aged and older adults

We examined health-related quality of life in adults in the Louisiana Health Aging Study (LHAS) after Hurricanes Katrina and Rita (HK/R) that made landfall on the U.S. Gulf Coast region in 2005. Analyses of pre- and post-disaster SF-36 scores yielded changes in physical function and bodily pain. Mental health scores were lower for women than men. Gender differences were observed in religious beliefs and religious coping, favoring women. Religious beliefs and religious coping were negatively correlated with physical function, implying that stronger reliance on religiosity as a coping mechanism may be more likely among those who are less physically capable.     

The law and emergencies: surveillance for public health-related legal issues during Hurricanes Katrina and Rita

Law influenced every aspect of the public health response to Hurricanes Katrina and Rita, from evacuation orders, to waivers of medical licensing requirements, to the clean-up of public health threats on private property. We used public health surveillance of news reports to identify and characterize legal issues arising during the disaster response in 5 Gulf Coast states. Data collected from news reports of the events in real time were followed-up by interviews with selected state legal and emergency management officials. Our analysis indicates the value of surveillance during and after emergency responses in identifying public health-related legal issues and helps to inform the strengthening of legal preparedness frameworks for future disasters.     

Health effects of exposure to water-damaged New Orleans homes six months after Hurricanes Katrina and Rita

Objectives. We investigated the relation between respiratory symptoms and exposure to water-damaged homes and the effect of respirator use in posthurricane New Orleans, Louisiana.Methods. We randomly selected 600 residential sites and then interviewed 1 adult per site. We created an exposure variable, calculated upper respiratory symptom (URS) and lower respiratory symptom (LRS) scores, and defined exacerbation categories by the effect on symptoms of being inside water-damaged homes. We used multiple linear regression to model symptom scores (for all participants) and polytomous logistic regression to model exacerbation of symptoms when inside (for those participating in clean-up).Results. Of 553 participants (response rate=92%), 372 (68%) had participated in clean-up; 233 (63%) of these used a respirator. Respiratory symptom scores increased linearly with exposure (P<.05 for trend). Disposable-respirator use was associated with lower odds of exacerbation of moderate or severe symptoms inside water-damaged homes for URS (odds ratio (OR)=.51; 95% confidence interval (CI)=0.24, 1.09) and LRS (OR=0.33; 95% CI=0.13, 0.83).Conclusions. Respiratory symptoms were positively associated with exposure to water-damaged homes, including exposure limited to being inside without participating in clean-up. Respirator use had a protective effect and should be considered when inside water-damaged homes regardless of activities undertaken.In August and September 2005, Hurricanes Katrina and Rita caused unprecedented flooding in New Orleans, Louisiana. In the aftermath, visible mold growth occurred in approximately 44% of area homes.1 Air sampling for mold spores conducted in October and November 2005 showed high levels both indoors and outdoors.2 Similar sampling in October 2005 showed elevated levels of endotoxin, a bacterial cell wall component, in water-damaged homes.3A 2004 Institute of Medicine report concluded that sufficient evidence exists for associating the presence of mold or other dampness-related agents in damp buildings with nasal and throat symptoms, cough, wheeze, asthma exacerbations in sensitized asthmatics, and hypersensitivity pneumonitis.4 Since that report, there has been additional evidence to suggest that asthma can develop during childhood5 and in the occupational setting6 as a result of exposure to dampness or mold.The conditions in New Orleans after the hurricanes thus posed a potential health risk to thousands of returning residents. In light of these circumstances, public health officials made recommendations on the use of personal protective equipment. Among these was the recommendation for the general public to use particulate respirators when around mold-contaminated dust, such as might be encountered during clean-up activities.7^,8 The risk of health effects for residents involved in activities less likely to disturb mold-contaminated materials, such as visually inspecting the interior of an affected home or collecting belongings, was thought to be lower. Thus, for such activities, the public was advised that respirators were not usually needed.8Although respiratory illness and asthma exacerbations have been noted following flooding,9 the contributory role to respiratory disease of postflood exposure to water-damaged homes has not been well documented. We sought to better understand the relation between respiratory symptoms and exposure to water-damaged homes in posthurricane New Orleans. Given the recommendation about respirator use and the observation that respirator use was common among the public following the hurricanes,10 a second objective was to determine the effect of respirator use on symptoms. We conducted a population-based investigation to address these issues.