The document summarizes the rebuilding of healthcare infrastructure in New Orleans after Hurricane Katrina. It describes the collaborative disaster planning that existed prior to Katrina. It outlines the strategic objectives in the first year after Katrina to rebuild hospitals, EMS, clinics, and public health services. Key lessons learned include the importance of relationships built through prior collaboration, local leadership, data-driven requests for assistance, and grassroots rebuilding strategies grounded in reality.

1. Rebuilding Community Healthcare after
Catastrophe:
The Post Katrina Experience
Jim Aiken MD
Associate Professor of Emergency Medicine and Public Health
Co Chair Division of Disaster Medicine and EMS
LSU Health Science Center
New Orleans, La.

2. Objectives
 Understand the features and history of collaborative
Metropolitan New Orleans healthcare disaster
planning prior to Hurricane Katrina.
 Describe core strategic objectives and goals employed
to rebuild Metropolitan New Orleans healthcare
infrastructure the first year post Hurricane Katrina.
 Be able to list lessons learned from the experience of
rebuilding healthcare infrastructure.

3. September 11, 2001

4. February 3, 2002

5. HRSA (Bioterrorism)Hospital
Preparedness Program
 Department of Defense and
Emergency Supplemental
Appropriations for Recovery from
and Response to Terrorist Attacks
on the United States Act, 2002,
 Grant funding to states with
guidance and deliverables:
integrated hospital planning
particularly WMD, infrastructure,
surge capacity, EMS, equipment
acquisition
 2003 La grant originally authored
by LA DHH, LHA, LSU

6. HRSA Hospital (Bioterrorism)Preparedness
Program 2003
 Largest and now sole
significant federal
funding source
healthcare management
emergency in USA
 Smallpox and other bio
weapons seen as major
threat

7. HRSA Hospital Preparedness
Program 2003
 Funding through state
health departments
 Regional platforms
 Surge capacity
 Medical counter measures
 Communications
 EMS
 Training/ drilling
 Equipment
 Not all hazards

8. Louisiana Hospital Preparedness
Program 2005
 Morphed into all hazards
 Every region with regional and
hospital designated
representatives
 Successive hurricanes threats
and strikes to Louisiana
bolstered collaborative planning
and preparedness
 Inter hospital communication
system: Motorola/ La State
Police
 Remarkable stability of
participating facilities and
personnel
 Strong leadership
2004

9. Overview Orleans Parish- Before
 450,000 population
 9 acute care hospitals
 Primarily paper medical
record system
 2 Academic Medical
Centers
 2200 hospital beds
 Trauma Center at
Charity Hospital

10. Overview of Charity Hospital
 One of nine Louisiana
public hospitals
 Trauma Center
 130,000+ ED visits
 >300,000 clinic
visits/year
 Sole source of medical
care for many
 Sole source of behavioral
health care for majority

11. Overview - Before
 Demographics:
predominately poor,
disadvantaged
 Low ranking healthcare
benchmarks
 Access primarily through
hospital based EDs and
clinics
VA
Charity Hospt
Tulane

12. Statewide Emergency
Management
 State Office of Emergency
Preparedness/EOC - 80 miles
away
 Includes separate desks for
Department of Health and
Hospitals, Louisiana Hospital
Association (HRSA Hospital
Network), and LSU Health
Care Services Division
 Sec. of Dept of Health and
Hospitals established a
forward command at the
Superdome- pulled out 3 days
after storm

13. February 28-29, 2005

14. August 29, 2005

15. Industrial Canal Break
Morning of Aug. 29, 2005

17. Charity Hospital
Tulane
After
VA
Charity

18. Flooding
10 M SPOT Satellite Image: 2 Sept 2005
With Water depth overlays
DeWitt Braud and Rob Cunningham

19. Immediate Aftermath
 Electricity and water out
 HRSA HPP DRC remained in
touch
 Most communication systems
out
 Landlines triangular
 Cell phone out
 Texting survived
 Satellite phones unreliable
 HRSA Motorola intact
 HAM radio intact

20. Katrina Toll
 >1800 died
 1.5M evacuated before
and after storm
 3200 unaccounted
 200,000 homes damaged
or destroyed

21. Katrina Toll
 >$100 B damage
 80% New Orleans
flooded
 Damage not by wind but
by standing water

22. Hospital Aftermath
 For first time in 300 years,
New Orleans is without a
single hospital bed
 All New Orleans hospitals
either destroyed or
surrounded by standing
water
 Wide spread medical records
destruction
 Emphasis on evacuation with
no hope of immediate
continuity of operations
 Suburban hospitals survived
Tulane
Charity
VA

23. Immediate Post Katrina
 Returned to N.O. on Sept. 6th
 No hospitals open in the parish- no organized patient
care sites
 City administered public health nonexistent
 Medical Schools and Health Science Center
infrastructure severely damaged- relocated classes to
Baton Rouge
 City evacuated down to 30,000 overnight residents

24. Immediate Post Katrina
 Cindy Davidson and Jim
Aiken at the ESF 8 at City
Hall. Later with the US
Public Health Service at
Ochsner Main.
 Northwest Medical Group
and LSU Emergency
Medicine establishes
Convention Center open
air patient care/evacuation
center
 USS Iwo Jima as first
medical backup.

25. Supply and Demand
 Initially our challenge was
to find places and supplies
to care for the remaining
residents
 Integrate with incoming
federal assets
 Challenge to get Incident
Command release of
available supplies and
equipment
 Continued city forced
evacuation

26. Immediate Post Katrina
 DMAT’s functioning as
extensions of existing hospitals
and support for evacuation
staging among other essential
functions
 City Emergency Operations
Center reactivated in Hyatt
Hotel and forms Unified
Command with outside
emergency managers
 Northwest Medical Group and
LSU Emergency Medicine
established Convention Center
open air patient care/evacuation
center

27. Greater Metropolitan New Orleans
Healthcare Task Force
 US Public Health Service
led task force of all
regional healthcare
entities
 Worked 10 US DHHS
Secretary Leavett action
items
 Operated strategically
and tactically
 Gradually morphed to
locally led task force

28. Response/Rebuilding Priorities
 Acute trauma care
 Time sensitive illnesses,
 Ambulatory care
 EMS and restoration of 911
 Remediation of damaged facilities and acquisition of
temporary facilities

29. Response Priorities
 Mental Health
 Public Health Surveillance
 Vector and rodent control
 Animal control
 Risk Communication

31. Trauma Care
 The mayor aggressively
promoted reentry
 Trauma became near
epidemic
 Established stabilization
units

33. USNS Comfort Sept. 2005
100 bed
Acute
Trauma
Hospital
Ship
Where ship was
needed
-------

34. Have to describe the need in terms of what, how
much, for how long, in the context of absolute
need
Planning for request for the USNS Comfort

35. LSU/Elmwood Trauma Hospital

36. Carolina MED-1

37. EMS and Time Sensitive Illnesses
 FEMA provided 25
Ambulances
 4 High Waters Trucks
 Uniforms
 Radios
 Housing
 Temporary Office Facilities
 Outlying hospital played
remarkable role in
maintaining access to time
sensitive illnesses

38. EMS Headquarters
Emergency Medical Surge
Unit

39. Facility capacity tracking

40. Ambulatory Care
 Began as individual efforts
canvassing the
neighborhoods for needs
assessments
 “Point of care” sites
developed accordingly
 Initially scavenged for
whatever could find, later
utilized unified command
 Crucial because CMS did
not reestablish modified
payment mechanisms for
private care

41. Community Clinics
 Covenant House
 Algiers Fisher Clinic
 Common Ground
 Heart to Heart
 Armed Forces
 Metropolitan Human
Services District
 Substance Abuse clinics

42. LSU Emergency Service Unit

43. LSU Outpatient Clinic
Former Lord and Taylor Store
Dec. 2005- Nov 2006
150-250 patients/day

44. Mental Health
 Initial CDC 10.05 Needs Assessment: 50% in need
Confirmed in later study Am J Orthopsychiatry . 2010 April ; 80(2):237–247
 SAMSHA Cruise ship
 Greatest failure to leverage federal aid
 Hospital based first year/ BHERE

45. Response priorities
 Public Health Surveillance
 Vector and rodent control
 Animal control
 Risk Communication
Public Health reluctant to disclose threats

46. Public Health
 Trauma- expected blunt and minor penetrating
 Respiratory- “Katrina cough”
 Rashes
 Stress related
 Mental health

47. Public Health
 Few true public health or epidemiological emergencies
 Initially exposure and lack of fundamental necessities-
dehydration
 Gastrointestinal issues
 Infections (soft tissue)- no known epidemics
 Initial statistics primarily hospital based

49. Public Health
 Lack of medicines
 Withdrawal syndromes
 Carbon monoxide poisoning
 Emphasis on surveillance and vaccination-
cholera?..hepatitis?....tuberculosis
 Water contamination- chemicals

51. Operation Phoenix
 Separate regional public health strategic planning
effort
 All levels of health care involved
 Goal was to merge with operational/tactical effort
 Issued Framework for a Healthier Greater New Orleans
Nov. 10, 2005
 Produce the guiding principles and rebuilding
priorities that would transcend the subsequent
planning efforts

52. Framework Guiding Principles
 Healthy neighborhood design
 Environmental health
 Enhanced core public health services: surveillance,
mental health/substance abuse, risk communications
 Enhanced primary and preventive care

53. Framework Guiding Principles
 Universal access to care and health insurance coverage.
Money follows the patient. Eliminate two tiered
system
 Hospital and Specialty Care: greater connectivity with
community based care
 Enhanced health information technology
 Health workforce: more primary care, mental health,
and extender graduates

54. Louisiana Recovery Authority
 State and local committees with the mission to design
the rebuilding of healthcare in Louisiana
 Administration of federal block grants in concert with
the state legislature
 Confusion over scope of mission: New Orleans or state

55. Bring New Orleans Back Commission Nov.
2005-Jan. 2006
 City initiated strategic planning effort
 Resisted strong mayoral pressure to remain
focused on N.O. only- only report to maintain
regional scope
 Healthcare committee followed the guiding
principles of the Framework for a Healthier Greater
New Orleans
 Rebuild Academic Medical Centers- crucial to
rebuilding provider workforce

56. Louisiana Health Care Redesign
Collaborative
 State Dept. of Health and Hospitals led coalition
of New Orleans region stakeholders
 Directives by Sec. Leavett in exchange for
governmental reimbursement waivers and
modification
 Community based access points with close ties to
institutions
 Emphasis on primary and preventive care
 Universal health insurance

57. Louisiana Health Care Redesign
Collaborative
 Increased home health opportunities
 “Money follows the patient, not the institution”
 Rebuild the academic health centers
 Improve access to mental health
 Pay for Performance

58. Hospitals reopen mid year
 Touro Hospital reopens (12.05)-200 beds
 Tulane Medical Center reopens (2.06) 200 beds
 Little private community care- capability continues to
be measured in makeshift community clinics and
regional Emergency Departments.
 Jefferson Parish hospitals continued to carry the load
of inpatient care
 Population continued to re enter

59. Let the show go on
Mardi Gras 2006

60. LSU University Hospital
 Opened November 2006
 Trauma hospital
 175 acute care beds-
saturated 90%
 Academic medical center
flagship
 Medical Schools
returning

61. Lessons Learned
 Relationships forged over years of collaboration,
cooperation, and cooperation become the determining
factor in disaster response
 HRSA hospital network was a saving grace
 Healthcare emergency management is cost effective
and efficient in terms of facility team building and
focus on daily operations

62. Lessons Learned
 Local municipal leadership crucial
 Have to understand the critical elements of the
Federal Response Plan
 Assistance requests must be data driven
 Balancing reentry with community services and safety
critical
 Grassroots level rebuilding strategies and goals must
grounded in political and proprietary reality

63. Lessons learned
 Strategic and subsequent tactical planning crucial for
continued forward progress and momentum
 Therapeutic for local participants
 Effective risk communication critical
 Redundant electronic medical records

64. Source of post-traumatic growth
 Becoming closer to their loved ones (81.2%)
 Faith and trust in others (68.4%)
 Spirituality or religion (64.7%),
 Finding deeper meaning and purpose in life (78.3%),
 Discovering inner strength (82.3%)
Bull World Health Organ. 2006 December ; 84(12): 930–939.
NIH Public Access

65. Lessons Learned
 The personal initiative remains the essential feature to
effective disaster response
 Reestablishing some element of personal normalcy
important
 Recognizing certain burnout and post traumatic stress
symptoms in self and others- being willing to ask for
help
 All disasters are local

66. Jim Aiken, MD
Associate Professor of Emergency Medicine and Public Health
Co Chair Division of Disaster Medicine and EMS
LSU Emergency Medicine Residency Program
New Orleans, La.
jaiken@lsuhsc.edu
504-666-1340