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In The Field

Katrina & Disaster Preparedness – What Will Change?

Irwin Redlener, center, president of the Children's Health Fund (CHF); Karen Redlener, Dr. Redlener's wife, co-founder and executive director of the CHF; and singer Paul Simon CHF co-founder, in Louisiana with Operation Assist days after the hurricane struck.

Irwin Redlener, center, president of the Children's Health Fund (CHF); Karen Redlener, Dr. Redlener's wife, co-founder and executive director of the CHF; and singer Paul Simon CHF co-founder, in Louisiana with Operation Assist days after the hurricane struck.

Shortly after his arrival in Biloxi, Mississippi, a town overflowing with distressed Katrina survivors, Irwin Redlener, M.D., the director of the Mailman School's National Center for Disaster Preparedness (NCDP), witnessed an encounter that seemed to encapsulate the extent of the calamity. "Somebody walked up to one of our Operation Assist mobile medical units and said, 'I'm a heart transplant patient and I can't get my immunosuppressant drugs. Can you help me?' This was on a street corner. There was no one in charge of medical care in this new town of evacuees, despite the presence of a huge number of military personnel and state and local officials."

Dr. Redlener, who traveled to Mississippi and Louisiana just days after the storm struck to launch Operation Assist – a new partnership between the Mailman School of Public Health and the Children's Health Fund providing mobile medical units in some of the areas hardest hit by Katrina – was astonished by the utter chaos and ill-preparedness everywhere.

In addition to urgent medical and mental health care, Operation Assist's six mobile teams are providing public health assessments and management. Richard Garfield, the Henrik H. Bendixen Professor of Clinical International Nursing and deputy director of Operation

Assist is overseeing plans to deploy state-of-the-art field laboratories for toxic and hazardous materials. Other Mailman School experts, including Paula Madrid, Ph.D., director of NCDP's Resiliency Project, and Beth Fuller, NCDP's special projects coordinator, are working on the assessment of general conditions and unmet health and mental health needs. Ginger Chew, Sc.D., assistant professor of environmental health sciences, is developing guidelines for people re-entering storm-ravaged communities.

If there is any silver lining, Dr. Redlener believes it may be that the catastrophe will spur greater awareness of the need for vastly improved disaster preparedness. "It's become a sad but real platform for preparedness advocacy," he says. "I had a talk with Ray Kelly, head of the NYPD, before going to the Gulf Coast, and believe me, it matters very much that we understand what went wrong in the evacuation and disaster response. It matters not only to us in New York City, but to all other urban areas in the United States."

One important factor in the poor response to Katrina was an unprepared and utterly misunderstood population. "It points out that we can't assume that everyone's going to behave the same way, that everyone will leave, that everyone's got a car and enough money to buy three days worth of food and water," he says.

A model of the Children's Health Fund's mobile medical van that went to the Gulf Coast to assist Katrina survivors.

A model of the Children's Health Fund's mobile medical van that went to the Gulf Coast to assist Katrina survivors.

The lack of care for the old, the sick and people with chronic illnesses was another major failure. Many hospitals and medical facilities in Mississippi and Louisiana were destroyed by the storm, and many residents didn't have access to insulin, dialysis machines or medicines for mental illnesses such as schizophrenia. The chronically ill among the thousands of evacuees who have filled up the small town of Pine, La., for example, didn't have their medical needs evaluated for weeks after the storm hit.

The suddenly urgent attention being focused on disaster preparedness gives the nation's schools of public health an opportunity to examine what went wrong in this disaster and help communities and governments improve disaster planning.

The Mailman School of Public Health opened its National Center for Disaster Preparedness in 2003. The center includes one of the nation's first CDC-funded Centers for Public Health Preparedness, which focus on preparing local health departments for outbreaks of infectious disease or bioterrorism, and programs to increase preparedness for children, schools, and other healthcare institutions.

Preparedness means planning, drills and testing of the efficacy of training. How effective are current methods?

"There's very little research and validation of the things that we know, or think we know, about disaster preparedness," Dr. Redlener says. "There have been many protocols developed on preparedness in the four years since 9/11, but we haven't really validated the drills, the tabletop exercises, the full-scale exercises, or anything we do. That immediately opens the door for schools of public health and other academic institutions to look much more carefully at what we think we know and to test our protocols."

One such project already under way in the School of Nursing looks at how accurately local health departments assess their own preparededness. "Now, after a drill, assessment is very informal. People say 'Yeah, we did that O.K,' or 'We need to do this better.' We're trying to provide specific measures," says Kristine Gebbie, Dr.P.H., director of the Center for Health Policy in the School of Nursing. For example, if a department needs to open a site for emergency vaccinations, Dr. Gebbie says a good response requires that all materials and personnel arrive to train staff at the site two hours before it opens to the public.

Even with the best-laid plans, though, a well-managed response to a disaster requires strong leadership. "You can't take a written plan and give it to somebody in the bureaucracy who doesn't appear credible, who doesn't have the information or the authority to command the response," Dr. Redlener says. "What the nation needs now is a new national discussion about what prepared means, how it's measured and what we should expect. Since 9/11, this country has spent tens of billions of dollars on preparedness, yet we can account for very little and can hardly say what has actually been accomplished."

—Susan Conova


CUMC in the Trenches

Lessons learned from Katrina will be put to use in future disasters, and a number of CUMC scientists and researchers are in the field trying to better assess issues that the hurricane brought to light.

The School of Nursing's Center for Health Policy is in regular communication with those coordinating national nursing volunteer efforts in Louisiana, Alabama and Mississippi. Joan Valas, staff member of the SON's Center for Health Policy, has been mobilized through the Disaster Medical Assistance Team to Biloxi, Miss.

Neil Boothby, Ed.D., professor and director of the Program on Forced Migration and Health at Mailman School of Public Health, is providing mental health support to children affected by Hurricane Katrina. Working with the Louisiana governor's office, Dr. Boothby, program alumni and current Mailman and Tulane students are training teachers and community workers in a rapid psychological response program that will be implemented in schools throughout the state. It is likely to be one of the largest preventative mental health programs ever undertaken in this country.