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Planning forDisaster Management

Lessons learned Katrina, Rita, Ike and

Gustav

Norman McSwain , MDProfessor of SurgeryTulane UniversityTrauma director

Spirit of Charity Trauma CenterMedical Director

PreHospital Trauma Life Support

Kyle F. Dickson, M.D. M.B.A.

Professor Baylor College of MedicineSouthwest Orthopaedic Group, Houston, Texas

kyledickson99@gmail.com cell 713-208-4168

Katrina 8 Years Later: Have We Learned Anything Yet?

Kyle Dickson MD, MBAProfessor of Orthopaedics Baylor College of Medicine

Southwest Orthopaedic Group

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Summary•Proper emergency management planning (Get Involved-ask?)–Food, water, generators, personnel,

patient evacuations •Military

–Security–Communications

Kyle F. Dickson, M.D.Professor and

Director of Orthopaedic Trauma,Tulane University

Chief of Orthopaedics, Charity HospitalClinical Assistant Professor, LSU

Disaster (sudden onset of unexpected circumstances)

•Natural (hurricane, earthquake, etc)•Mechanical (bus rollover, tanker hitting casino, multi vehicle collisions, explosions, wind, etc.)•Biochemical (government most concerned)

“Explosions and bombings remain the most common deliberate cause of

disasters involving large numbers of casualties'”

Sherma, Am J disaster Med2008

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Beautiful Lakeview House for Sale

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New Orleans HurricanesAugust 1779

Lessons learned from ground zero

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“New Orleans has dodged a bullet”

90.04.32w29.57.18n Wind

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WindHurricane Mark Twain 1883

• “There is nothing but that frail breastwork of earth between the people and destruction”

9:50am Monday August 29, 2005

Surge >50 feet, Lake Ponchartrain elevated 15 feet 18th Street Canal

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Levee Breaks

Before After

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Industrial Canal Break FloodWater comes and stays

Charity HospitalTulane

After

VA

University Hospital

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80% of the city was underwater 90%of the homes

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On the Streets

A diabetic

Prisoners on the Interstate

Days without water or food while the world

watched and FEMA trucks drove by

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Canal St.

Six Flags -- Jazzland Power

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PowerEmergency (generator ) power (24 hours vs 80 hours, basement)•Red plugs•Ventilators, Operating Room, Selected lights•EMR, Radiology, Lab, Pharmacy, Communication

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Lesson 1•Proper Emergency planning–Worst case scenario planning (Munich –F.E.M.A.)–Hundreds of school buses underwater (use of resources)

Lesson 1–Common sense construction (generators in the basement or filled on the first floor, fuel two blocks away -80 hours)–Triage (who lives and who dies)

Planning and ManagementProblems

Inappropriate planningnot

mistakes in field-level decision makingSuccesses

Initiatives in front line medics compensated for lack of clear command

by senior managersCritical thinking by field personnel

CarresiDisaster 2008

Madrid bombing

Response• Immediate

– 2-5 days– Local resources only– Preparation– Storage– Communication– Command & control– Security– Evacuation

SanitationWater

Kitty literDisposal bags

Cleanser

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Toilet paper…Check Bud Light…Check Keystone Ice…CheckBudweiser…Check Red Dog…Check

Misc. Other bottles of Alcohol…CheckPiece of Plywood to Float Your Chick and Booze on…Check

NEXT TIME, LET’S ALL BE BETTER PREPARED

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Lesson 2•Security is number one issue–Lawless society (superdome – rape, murder, pillaging, vandalism, etc.)–Military presence ASAP ( “national valued asset”)–Hospital lockdown (inundated with health care providers 4-5/1)

In a grab and run test, Heineken was the number one choice of beer for looters in the New Orleans metropolitan area. When asked,

most agreed that Colt 45 or Red Dog was their main beer of purchase, but when money doesn’t matter,

they grab for the finest beer around, Heineken.

Thank you, New Orleans, for making us number one.

Response

Reliable communication – Satellite phones (Ham radio system)

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Response• Immediate

– 2-5 days– Local resources only– Preparation– Storage– Communication– Command & control– Security– Evacuation (planned arrangements)

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Hemingway called courage “grace under pressure”

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Lesson 3•Communications–Between hospital and helicopters (other hospitals or the outside world)–Military –Orthopedic surgeons should be in charge (a lot less “dickin around”)

Response• Immediate

– 2-5 days– Local resources only– Preparation– Storage– Communication– Command & control– Security– Evacuation

Towers down or damagedBatteries run out

without recharging

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“Lagniappe (spanish) …is the equivalent of the thirteenth roll in a “baker’s dozen”

Mark Twain

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A beached boat on Napoleon?

Fats Domino’s Living Room(The Fat Man – “Bluberry Hill”)

Before

After

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Individual Lessons•The water was toxic (admitted with sepsis)•The water didn’t just come and go but stayed for 4 weeks • Insurance companies are crooks (maximum allowable flood only 1/3 cost of the house – no home owners)

Long Black LineSpencer Bohrren

Rescue evacuation

1300 found in the attic

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Debris

34 Normal Years of

Garbage in 3 Months

Myths of disaster managementI’m from the government I am here to help you

You are on your own for 72 hoursThere is no help

Hurricanes Gustav and Ike• A new challenge – two hurricanes – two coasts - back to back• Orleans Parish hospitals evacuate pre-storm– LSU evacuated to other LSU hospitals– Tulane evacuates to other HCA hospitals– Ochsner Baptist evacuates to other

Ochsner hospitals

Command and Control• Most important change from Katrina to Gustav• Coordinated command and control• Leadership• Power and control• Private (HCA) and Public ( Charity) worked• Government system (FEMA) did not work

We must fend for ourselvesThe government is NOT here to help

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Disaster aftermathThe US Third World

Human Resources• Medical• Administration• Infrastructure workers• Fatigue• Shift work

Non Human Resources• Power

– Electricity– Gas

• Water– Potable– Non Potable

• Sanitation• Food• Medication• Equipment• Supplies• Communication• Transportation

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My Plea•Get involved! Orthopaedist are needed (IGOT-OTI)–Hospital emergency preparedness–Third World volunteerism

�Time�Money�Sponsorship

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Summary•Proper emergency management planning (Get Involved)–Food, water, generators, personnel,

patient evacuations, family•Military

–Security–Communications

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New Orleans 2 Years Later• Minimal Rebuilding in Lakeview• No guarantee levee can with stand level 5 hurricane• Insurance paid one third of the cost of the house• ? Return of the “Soul” of New Orleans

Year 2 “I Wish I …”• Backed up thousands of patients in research studies• Taken a greater role in Emergency Management for the hospital (satellite communications, evacuation plans, power, water, security, and staffing)• Personal emergency preparedness

What I Wish I Knew•Planning (2-3 days to prepare not plan)• Indentification/Badge for disaster•Water/Food•Family safe•Communication (satellite phones, ham radios)

Guilty•Ran form New Orleans, ran from Baton Rouge to Houston–Appreciation for my patients

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Guilty�“finddoctordickson.com”�Nice to see friendly faces in hostile lands

–Art of medicine (not the business or science of medicine)

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Studs Terkel wrote, “Hope has never trickled down. It

has always sprung up”

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“Let the city return to the swamp”• Music – The beginnings of Jazz, Blues, Zydeco, Gospel, Cajun and Creole (Louis Armstrong “What a Wonderful World”,Fats “Blueberry Hill”, Aaron Neville “Louisiana 1927”) • Food – The amalgamation of all countries of the world

The sounds and the flavors that are yet to be created

Although a third of the population lived below the poverty line, a culture of free and collective amusement has

emerged

Mardi Gras 2009• 1699 French explorer Iberville• ?Largest preplanned disaster in the U.S. (maybe world)•Population 350,000 to 10 million over 2 weeks

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Final Lesson• The best and the worst of humanity•What really is Important

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Thank You