Chapter Chapter 4
Section Federal Health and Medical Support
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Federal Health and Medical Support
The public health and medical situation throughout the Gulf Coast required substantial Federal resources to prevent even further loss of life. On August 31, HHS Secretary Leavitt declared a Federal Public Health Emergency for the Gulf Coast region. This emergency declaration allowed HHS to waive certain requirements for such programs as Medicare, Medicaid, and the State Children’s Health Insurance Program. It also allowed HHS to make grants and enter into contracts more expeditiously.193 Immediate public health and medical support challenges included the identification, triage, and treatment of acutely sick and injured patients; the management of chronic medical conditions in large numbers of evacuees with special health care needs; the assessment, communication, and mitigation of public health risks; mortuary support; and the provision of assistance to State and local health officials to quickly reestablish health care delivery systems and public health infrastructures.194
Federal departments and agencies worked together to attempt to meet these challenges, beginning before Hurricane Katrina’s landfall and continuing long after. HHS and DOD health officials collaborated with State and local health officials, maintained situational awareness for their respective agencies, and hastened the direction of medical and public health assets. National Disaster Medical System (NDMS) teams also formed an integral component of the medical response to Hurricane Katrina, collectively treating over 100,000 patients.195 Several agencies assigned responsibilities in the NRP under ESF-8, Public Health and Medical Services, sent liaisons to the HHS Operations Center in Washington, D.C., and the HHS Secretary’s Emergency Response Teams (SERTs) in the affected States. The Department of Veterans Affairs (VA) used its extensive resources to deliver care to evacuees and veterans from the affected region.
HHS deployed medical supplies and personnel to bolster State and local public health capacity in the region. It provided pharmaceuticals and other medical supplies from the Strategic National Stockpile (SNS) beginning with pre-landfall deliveries to the Superdome. By September 3, HHS had delivered 100 tons of medical supplies from the SNS to Louisiana. HHS also deployed twenty-four public health teams that included epidemiology, food safety, sanitation, and toxicology experts.
Medical and public health assets provided excellent care to thousands of displaced patients with both acute injuries and with chronic medical conditions, many of whom had multiple complex medical requirements. According to the Governors from the Gulf Region, medical and public health professionals were true heroes of the Hurricane Katrina response. They often had to improvise and use their own initiative because the system was slow to deploy them from staging areas or failed to adequately supply them. A member of an American Red Cross inspection team, Dr. Hilarie H. Cranmer, wrote, “ i n a little over four days, our multidisciplinary and interagency teams assessed more than 200 shelters housing nearly 30,000 people. Amazingly, in a majority of cases, the basic public health needs were being met.196 Federal, State, local, private sector, and volunteer health care providers across the Gulf Coast took the initiative to overcome the inefficiencies of the medical support system and meet their patients’ needs.197; Louisiana State University worked with the State Office of Emergency Preparedness, Federal personnel, and responders from outside the region to turn its Pete Maravich Assembly Center into an acute care medical facility. Within a week, the facility processed approximately 6,000 patients and more than a thousand prescriptions.198
Lessons Learned:
In coordination with the Department of Homeland Security and other homeland security partners, the Department of Health and Human Services should strengthen the Federal government’s capability to provide public health and medical support during a crisis. This will require the improvement of command and control of public health resources, the development of deliberate plans, an additional investment in deployable operational resources, and an acceleration of the initiative to foster the widespread use of interoperable electronic health records systems.
HHS struggled in its NRP role as coordinating agency for ESF-8. HHS lacked control over vital medical assets, over-relied on departmental routines, and did not have adequate disaster plans. FEMA compounded HHS coordination difficulties. FEMA deployed NDMS teams without HHS’s oversight or knowledge. FEMA administrative delays in issuing mission assignments exacerbated the lack of coordination within ESF-8 and created additional inefficiencies. In order to respond swiftly, HHS felt compelled to take emergency response actions without mission assignments, bypassing FEMA. While this may have pushed additional assets to the region, it also had a deleterious effect on the Federal government’s situational awareness of its deployed assets.
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