Hurricane Katrina and the healthcare infrastructure: A focus on disaster preparedness, response, and resiliency

The aftermath of Hurricane Katrina provides a window of opportunity to address a frail and failing healthcare system. Katrina was the rare incident that disrupted the external systems supplying hospitals with key services and resources needed for the organizations to function; increased the number of patients, both present and expected, that required medical care; and affected directly the physical plants of the hospitals, challenging their functionality. Sorting through and gleaning useful lessons to increase the resilience of hospitals for this type of catastrophic incident will take time and will require system-wide public health planning and intervention. In this article, the authors focus on how hospitals prepared for, responded to, and coped with Katrina. They also provide a brief overview of the current situation and the healthcare crisis confronting hospitals and communities in the region affected by Katrina and discuss the impending need to develop disaster-resilient medical and healthcare systems. Planning, access to adequate resources, networking, effective communication and coordination, and training and education of doctors, nurses, technicians, and medical staff are essential in the development of a resilient healthcare infrastructure that will be able to provide the much needed services to populations affected by future disasters.     

Analysis of media agenda setting during and after Hurricane Katrina: implications for emergency preparedness, disaster response, and disaster policy

Media agenda setting refers to the deliberate coverage of topics or events with the goal of influencing public opinion and public policy. We conducted a quantitative content analysis of 4 prominent newspapers to examine how the media gathered and distributed news to shape public policy priorities during Hurricane Katrina. The media framed most Hurricane Katrina stories by emphasizing government response and less often addressing individuals' and communities' level of preparedness or responsibility. Hence, more articles covered response and recovery than mitigation and preparation. The newspapers studied focused significantly more on government response than on key public health roles in disaster management. We discuss specific implications for public health professionals, policymakers, and mass media so that, in the future, coordination can be enhanced among these entities before, during, and after disasters occur.     

The integration of mental and behavioral health into disaster preparedness, response, and recovery

The close interplay between mental health and physical health makes it critical to integrate mental and behavioral health considerations into all aspects of public health and medical disaster management. Therefore, the National Biodefense Science Board (NBSB) convened the Disaster Mental Health Subcommittee to assess the progress of the US Department of Health and Human Services (HHS) in integrating mental and behavioral health into disaster and emergency preparedness and response activities. One vital opportunity to improve integration is the development of clear and directive national policy to firmly establish the role of mental and behavioral health as part of a unified public health and medical response to disasters. Integration of mental and behavioral health into disaster preparedness, response, and recovery requires it to be incorporated in assessments and services, addressed in education and training, and founded on and advanced through research. Integration must be supported in underlying policies and administration with clear lines of responsibility for formulating and implementing policy and practice.     

Disasters and the public health safety net: Hurricane Floyd hits the North Carolina Medicaid program

OBJECTIVES: We measured the effect of Hurricane Floyd on Medicaid enrollment and health services use in the most severely affected counties of North Carolina. METHODS: We used differences-in-differences models on balanced panels of Medicaid claims and enrollment data. RESULTS: Overall spending per enrollee showed little short-term effect but demonstrated a moderate increase 1 year after the storm. We found very modest short-term increases in Medicaid enrollment, a small long-term decrease in enrollment, and large increases in the long-term use of emergency room and outpatient services. CONCLUSIONS: Our findings suggest that hurricane victims experienced substantial changes in patterns of care that endured for much longer than the initial crisis period. These findings can have important implications for the management of disaster relief for this population.     

Disaster mythology and fact: Hurricane Katrina and social attachment

Misconceptions about disasters and their social and health consequences remain prevalent despite considerable research evidence to the contrary. Eight such myths and their factual counterparts were reviewed in a classic report on the public health impact of disasters by Claude de Ville de Goyet entitled, The Role of WHO in Disaster Management: Relief, Rehabilitation, and Reconstruction (Geneva, World Health Organization, 1991), and two additional myths and facts were added by Pan American Health Organization. In this article, we reconsider these myths and facts in relation to Hurricane Katrina, with particular emphasis on psychosocial needs and behaviors, based on data gleaned from scientific sources as well as printed and electronic media reports. The review suggests that preparedness plans for disasters involving forced mass evacuation and resettlement should place a high priority on keeping families together--and even entire neighborhoods, where possible--so as to preserve the familiar and thereby minimize the adverse effects of separation and major dislocation on mental and physical health.     

Public health and natural disasters: disaster preparedness and response in health systems

The number of natural disasters and the severity of their impact have increased in recent decades. These developments highlight the need for improved preparedness and response in the health sector, inter alia, and the important role of public health in disaster management. The purpose of this paper, which is based on a literature review, is to provide background information about the general framework of disaster management and present the core concepts of disaster preparedness and response in health systems. Three different strategies were used to collect information for this article. First, information was collected from various international databases. Then, the virtual health library for disasters provided by the World Health Organization (WHO) and the WHO Health Action in Crisis (HAC) online sources were reviewed for relevant WHO and Pan American Health Organization (PAHO) books, working papers and reports. Finally, PubMed abstracts were searched with key words and phrases. For greater completeness, five disaster journals were hand searched. Additional sources such as text books, working papers, and articles were included, relying on the bibliography of the original study mentioned in the introduction to this paper. The studies reviewed indicated that fragmented and response-oriented approaches have begun to change world wide, at least in the literature. Despite the publication of increasing numbers of research projects in disaster issues, there are still gaps in sharing experience through scientific papers, such as systematic evaluation of activities in different phases of disaster situations.

ISEA2007 panel: integration of better exposure characterizations into disaster preparedness for responders and the public

An expert panel was convened in October 2007 at the International Society for Exposure Analysis Annual Meeting in Durham, NC, entitled "The Path Forward in Disaster Preparedness Since WTC-Exposure Characterization and Mitigation: Substantial Unfinished Business!" The panel prospectively discussed the critical exposure issues being overlooked during disaster responses and highlighted the needs for an optimal blending of exposure characterizations and hazard controls within disaster settings. The cases were made that effective and timely exposure characterizations must be applied during responses to any disaster, whether terrorist, manmade, or natural in origin. The consistent application of exposure sciences across acute and chronic disaster timelines will assure that the most effective strategies are applied to collect the needed information to guide risk characterization and management approaches. Exposure sciences must be effectively applied across all phases of a disaster (defined as rescue, reentry, recovery, and rehabitation-the four Rs) to appropriately characterize risks and guide risk-mitigation approaches. Failure to adequately characterize and control hazardous exposures increases the likelihood of excess morbidity and mortality. Advancing the infrastructure and the technologies to collect the right exposure information before, during, and immediately after disasters would advance our ability to define risks and protect responders and the public better. The panel provided conclusions, recommendations, and next steps toward effective and timely integration of better exposure science into disaster preparedness, including the need for a subsequent workshop to facilitate this integration. All panel presentations and a summary were uploaded to the ISES(1) website (http://www.iseaweb.org/Disaster_Preparedness/index.php).     

Evidence of the effectiveness of health sector preparedness in disaster response: the example of four earthquakes

In this article, evidence that health sector preparedness improves response performance in disasters was examined. Case fatality and survival data were compared for four earthquakes, in relation to health sector emergency preparedness levels. Vast differences in performance were found. The two California systems, with a high preparedness index, had low case fatality rates (about one death per 100 injuries). Kobe, Japan, with mixed levels of preparedness, had 31 deaths per 100 injuries, and Armenia (low preparedness index) had 167. Public health and health sector preparedness made a significant difference in the ability to respond effectively to meet patient needs in disasters, although it is only one of several factors that determine the health outcome of disaster victims.