Children's hospitals meeting the challenge together.

WHEN Hurricane Katrina turned toward Louisiana, children’s hospitals and pediatricians from around the nation mobilized to assist Children’s Hospital of New Orleans (CHNO) and other area hospitals with patient evacuation, supplies, volunteers, and equipment. The successful evacuation of 72 seriously ill children from CHNO, completed within 24 hours after the decision to evacuate was made, transpired with the help of multiple children’s hospitals and many Louisiana hospitals. This experience bears out the fact that no hospital, and indeed, no locality, can rely solely on itself when a disaster occurs. Overall, I believe it is fair to say that the nation’s pediatric community responded to Katrina well. However, I do not believe that there is a question in anyone’s mind that we could have done better, that in some cases a child’s care slipped through the cracks, or that the next hurricane might be bigger. As surely as Hurricane Katrina left destroyed buildings and flooding in its wake, she left behind an opportunity that pediatric providers cannot ignore: the opportunity to strengthen health care for all children. By examining what worked and what did not work, this supplement takes an important step in that direction. As the association that represents children’s hospitals nationwide, the National Association of Children’s Hospitals and Related Institutions had a bird’s eye view of the pediatric community’s response to Katrina. What worked was the high level of cooperation among pediatric health care providers, including the 4 children’s hospitals that aided directly in the CHNO evacuation with helicopters and planes. Many hospitals accepted displaced patients, dozens of children’s hospitals provided volunteers that worked alongside hundreds of individual pediatricians in the aftermath, and several children’s hospitals held fundraisers for CHNO. The strong response of children’s hospitals to Katrina victims was the result of years of networking that solidified the relationships of decision-makers and, most importantly, built trust. The strong bonds that most children’s hospitals have with specialty and community pediatricians helped communities provide immediate care for injured children and ensured that healthy children stayed that way even as they took refuge in cities across the United States. Working side by side with community pediatricians, child-focused organizations in the region, and other community hospitals, children’s hospitals were reminded that knowing who to call and how to get hold of them is not a luxury but a necessity. The lack of communication and mutual support between disaster-planning agencies and CHNO was clear. At more than one point during the storm and subsequent flooding, CHNO leaders were unsuccessful in obtaining help from federal, state, and local agencies. This lack of communication forced children’s hospitals and pediatricians to create solutions to problems that had not been experienced in the past, and certainly not on the scale of this disaster. In one instance, 2 ventilator-dependent infants were transferred to CHNO from another hospital via a small boat paddled by residents in the early hours of the storm. In another, a make-shift helipad was set up on a grassy field near the hospital with event