Preparing, Improvising, and Caring for Children During Mass Transport After a Disaster

THE INCAPACITATING BLOWS dealt to the New Orleans, Louisiana, health care infrastructure by Hurricane Katrina and its aftermath are unprecedented in the United States. Much can be learned about disaster preparedness from the events that unfolded in New Orleans after Katrina swept the Gulf shoreline. Problem areas in the management of this disaster such as internal and external communication failures, transportation, triage, personnel allocation, and resource allocation have long been identified in the literature as core disaster-response issues.1–3 In addition, damage to the physical plant, water and power system failures, and hazardous-materials exposure are encountered commonly in the face of disaster.1 Between 1950 and 2005, 286 hospital evacuations have been described, including horizontal evacuation (within the same floor), vertical evacuation (between floors), evacuation of a ward or wing, and complete hospital evacuation.4–10 Of the 286 between 1971 and 1999, 275 were reviewed by Sternberg et al.8 There are 22 reported cases of complete hospital evacuation since 1950; of these, 1 occurred in Canada and 8 resulted from the 1994 Northridge, California, earthquake.4,5,7–18 Of 43 reported incidents for which duration is known, only 12 evacuations lasted longer than 24 hours.8 Eleven percent of evacuations in the series reviewed by Sternberg et al listed at least 1 casualty, and the deadliest reported hospital disaster occurred in 1971, when partial collapse of a California Veteran’s Administration hospital claimed 49 lives.8 Hurricanes are the third most common cause for hospital evacuation, accounting for 38 of 286 reported evacuations; only internal fire and internal hazardous-material events are more common. It is notable that only 3 evacuations since 1950 involved 1000 or more patients.8 LOCAL EXPERIENCEWITH DISASTER Over a 5-day span in June 2001, Tropical Storm Allison brought nearly 39 inches of rain to Houston, Texas, including the Texas Medical Center (a consortium of health care institutions comprised of 2 medical schools and 13 hospitals with more than 6000 licensed beds). Tropical Storm Allison’s record rainfall and subsequent flooding, estimated by flood experts to be in the 300to 500-year range, claimed 22 lives and caused more than 2 billion dollars in damage to the Texas Medical Center alone.4,19 Disaster-management issues identified during Tropical Storm Allison served as the impetus for improved interinstitutional coordination among local hospitals during disaster and ensured that institutional investment in ongoing preparedness remained a priority. Such preparedness in each of these areas was integral to the overall positive outcome experienced by Texas Children’s Hospital (TCH). Our ability to respond to Hurricane Katrina effectively was the result of previous experiences and a specific focus on disaster preparedness over several years. Our response to Hurricane Katrina resulted in additional changes in our approach to disaster planning that will be described for each aspect of disaster preparedness.