There are many lessons to be learned from the 2005 Gulf hurricanes, and they directly affect public health preparedness here in Maine. While no one can predict the precise nature of the disaster that our medical personnel may be called on to respond to, the Gulf hurricanes have much to teach us about preparing for the unexpected. I recently spoke at the Annual Public Health Emergency Preparedness Conference at the Augusta Civic Center where I had the opportunity to reflect on these lessons learned and express my thoughts on what we must do be better prepared for future disasters with 250 medical professionals, first responders, and state and local emergency managers.
Last September, just days after Katrina made landfall, the Senate Homeland Security Committee that I chair launched an investigation into the flawed preparation for and response to this devastating storm. A six-month inquiry that the Ranking Member Joe Lieberman has described as the most comprehensive and bipartisan investigation in his 18 years in the Senate ensued. The Committee has held 22 hearings, heard testimony from 85 witnesses, conducted more than 300 formal interviews and examined some 820,000 pages of documents.
It is clear that many medical professionals on the front lines of Hurricanes Katrina and Rita performed heroically, going above and beyond the call of duty even when their best efforts were stymied by communications and leadership failures. They had the will, but in far too many instances they simply did not have the way.
Yet despite these countless individual efforts, some of the most horrific failures in the immediate aftermath of Katrina took place at nursing homes in Louisiana where officials failed to order the evacuation of nursing homes in flood plains. The result was a tragic loss of life and needless suffering. Essentials such as safe drinking water and fuel for emergency generators were quickly depleted. Communications were largely non-existent. Pre-storm plans to move patients and nursing home residents existed only on paper. Although the storm itself did not produce a great many injured, the failure to plan for the special-needs population – those requiring dialysis, oxygen, medications and other ongoing services – soon created a health care crisis. The needless loss of dozens of lives at nursing homes illustrated the awful consequences.
But the failures in medical response were not limited to state and local governments. The federal response also suffered from a lack of planning, coordination, and cooperation, particularly between the Departments of Health and Human Services (HHS) and the Departs of Homeland Security (DHS). The federal agencies involved in medical assistance did not have the right type or mix of medical capabilities to fully meet the needs arising from Katrina, such as serving large evacuee populations, and were forced to use improvised and unproven techniques.
Despite its lead role as the primary agency in charge of coordinating the federal medical response, HHS did not deploy its teams as rapidly as it should have, and it lacked adequate staff and resources. Despite efforts by both FEMA and HHS to activate the National Disaster Medical System and the U.S. Public Health Service as Katrina approached, only a small number of federal medical teams were actually in position prior to landfall. Despite the slow pace of Katrina’s approach, only one team was in a position to provide immediate medical care in the aftermath of the storm.
Yet even in this environment of systemic failure, medical professionals throughout the Gulf Region emerged as true heroes. Many worked past the point of exhaustion, often at great risk to their own health and safety. Despite the loss of power and the low fuel supplies, they exhibited great ingenuity in keeping essential equipment running. With drinking water and food at a premium, they put themselves on strict rations so that those they were treating would have more. They alleviated misery, and they saved lives.
The Committee’s final report will include recommendations that allow us to learn from the problems associated with Katrina, address these critical flaws now, and ensure far better planning and logistics in the future. We will call for a thorough restructuring of our national emergency management system that will produce the needed coordination, cooperation, and cohesion. Our purpose is to see that the lessons of Katrina are lessons learned, not merely problems observed.
If there is one paramount lesson of Katrina it is that the emergency management partnership must be strengthened through a foundation of trust, respect and a focus on mission. Regardless of the type of disaster Maine might face, an effective response will depend upon strong coordination among public health officials, emergency managers, health care professionals, and first responders. While Katrina highlighted the shortcomings in our emergency preparedness system, it is also illustrated in no uncertain terms that our nation is blessed with committed first responders who perform with outstanding skill, courage and selflessness when others are in need. We can, and we must, craft an emergency management system that is worthy of their efforts.