The experience of setting up the "Katrina Clinic" at the Astrodome/Reliant Center Complex in Houston provides important lessons to cities planning a medical response to disasters and other large-scale emergencies, reports a paper in the September issue of the Southern Medical Journal (SMJ), official journal of the Southern Medical Association.
Dr. Thomas F. Gavagan of Baylor College of Medicine and colleagues relate and evaluate their experience in providing medical care for thousands of evacuees from Hurricane Katrina. In an accompanying editorial, Dr. Neil J. Nusbaum of University of Illinois College of Medicine, Rockford, calls for a "fundamentally different approach" to disaster planning, including conversion of disused military bases into fixed evacuation sites.
For several reasons, the situation in Houston was "logistically and politically" conducive to receiving and treating large numbers of evacuees. Most importantly, the area was not affected by Hurricane Katrina, leaving its extensive health care system intact and ready to respond. A wide range of academic, governmental, and private organizations came together to make and implement plans for the Katrina Clinic. A key first step was the creation of a unified command and control system to direct and coordinate services—a public health infrastructure equivalent to that of a small town was created almost literally overnight.
The Clinic was built in a 100,000-square-foot space in the Reliant Arena. Within 12 hours—aided by the use of existing exhibit hall materials— workers had created a facility including 65 examination rooms. Over the next 2 weeks, the Katrina Clinic saw more than 11,000 of the estimated 27,000 evacuees seeking shelter in the Complex. Clinic staff wrote nearly 17,000 prescriptions, performed nearly 600 x-rays and other radiologic studies, and gave more than 6,000 vaccinations.
Common problems observed at the Katrina Clinic included uncontrolled high blood pressure, respiratory infections, and GI infections. Many evacuees needed treatments to control chronic diseases like diabetes and asthma. Dermatitis and other skin conditions, likely caused by exposure to contaminated floodwaters, were common. Many evacuees had acute emotional problems in need of immediate attention, while others had potentially serious psychiatric conditions. Children and the elderly accounted for a large percentage of evacuees, and posed special requirements to ensure their health and safety.
Among the many obstacles encountered was the lack of a system for identifying and registering evacuees in the overall shelter population. In many cases, patients seen at the clinic couldn't be found for follow-up, such as when important test results came back. Another challenge was confirming the credentials of health care professionals volunteering to help at the clinic—some were retired doctors or nurses with expired licenses, while at least one impostor falsely claimed to be a doctor.
The authors hope their experience—the successes as well as difficulties—will prove useful to other communities in preparing the medical response to future disasters. "With adequate planning and organization, supervision and cooperation, resources and leadership, other communities can respond fully and successfully, as did Houston and Harris County in the aftermath of Katrina," they conclude.
In his editorial, Dr. Nusbaum offers a tough critique of the overall public health response to Katrina, which he characterizes as a "debacle." Areas of weakness played out in succession, including the lack of an effective evacuation plan, the inability to provide aid to those left behind in the storm area, the "ad hoc" evacuation process, and the "continued diaspora" of much of the affected community.
Dr. Nusbaum proposes a fundamentally different approach to preparing for mass evacuations in the future, based on the premise that it is easier and safer to transport people from an unsafe to a safe area than to transport resources into a disaster area. He suggests outfitting disused military bases as a network of evacuation centers, equipped in advance with water, food, medical supplies—even buses. "The infrastructure to support fixed evacuation sites might or might not be more costly than a single lengthy aid operation under the current approach for a single disaster, such as Katrina," Dr. Nusbaum writes. "Use of multiple sites would make it likely that wherever in the country a disaster struck, an evacuation site would be relatively close by and fully intact."