Chapter Chapter 5
Section Critical Challenge: Public Health and Medical Support
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Critical Challenge: Public Health and Medical Support
Hurricane Katrina created enormous public health and medical challenges, especially in Louisiana and Mississippi—States with public health infrastructures that ranked 49th and 50th in the Nation, respectively.49 But it was the subsequent flooding of New Orleans that imposed catastrophic public health conditions on the people of southern Louisiana and forced an unprecedented mobilization of Federal public health and medical assets. Tens of thousands of people required medical care. Over 200,000 people with chronic medical conditions, displaced by the storm and isolated by the flooding, found themselves without access to their usual medications and sources of medical care. Several large hospitals were totally destroyed and many others were rendered inoperable. Nearly all smaller health care facilities were shut down. Although public health and medical support efforts restored the capabilities of many of these facilities, the region’s health care infrastructure sustained extraordinary damage.50
Most local and State public health and medical assets were overwhelmed by these conditions, placing even greater responsibility on federally deployed personnel. Immediate 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 risk; and the provision of assistance to State and local health officials to quickly reestablish health care delivery systems and public health infrastructures.51
Despite the success of Federal, State, and local personnel in meeting this enormous challenge, obstacles at all levels reduced the reach and efficiency of public health and medical support efforts. In addition, the coordination of Federal assets within and across agencies was poor. The cumbersome process for the authorization of reimbursement for medical and public health services provided by Federal agencies created substantial delays and frustration among health care providers, patients and the general public.52 In some cases, significant delays slowed the arrival of Federal assets to critical locations.53 In other cases, large numbers of Federal assets were deployed, only to be grossly underutilized.54 Thousands of medical volunteers were sought by the Department of Health and Human Services (HHS), and though they were informed that they would likely not be needed unless notified otherwise, many volunteers reported that they received no message to that effect.55 These inefficiencies were the products of a fragmented command structure for medical response; inadequate evacuation of patients; weak State and local public health infrastructures56; insufficient pre-storm risk communication to the public57; and the absence of a uniform electronic health record system.
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.
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