Hurricane Katrina struck a devastating blow to health care in New Orleans and environs, crippling most hospitals, destroying virtually all nursing homes, shutting down two medical schools, and wiping out thousands of physicians practices. These impacts to the region will likely be studied for years, but important lessons for our nations health care system should already have been learned. I witnessed the overwhelming health care challenges, having just returned from New Orleans, where our team of ophthalmologists from the Bascom Palmer Eye Institute of the University of Miami Miller School of Medicine provided emergency eye services to storm victims and first responders. We clearly saw that were it not for the heroic efforts of many of the regions physicians, nurses, and emergency personnel, the death toll at health care institutions would have been even greater.
It is inconceivable to most Americans that in the 2lst century, our societys most critical places of refuge -hospitals and nursing homes – could become Darwinian triage stations where medical staff made agonizing decisions about who would live and who would die. Patient safety has become a major concern in American healthcare. We spend a lot of time designing and implementing systems to prevent medication errors or mistakes in the operating room. Our experience after Katrina dictates that we pay immediate attention to an even more basic aspect of patient safety: protecting our patients and hospitals during a natural disaster or a man-made catastrophe. These compelling lessons have already emerged for our nations health care delivery system:
(l) Insist on state-of-the-art structural integrity for our hospitals and nursing homes. Herbert Saffir, the structural engineer who first formulated the hurricane intensity scale, has stated that hurricane planning needs to start with the building code. A similar warning applies outside the tropical cyclone zone. Major hospitals in California remain vulnerable to earthquake damage. After the 1994 Northridge earthquake, Los Angeles County Hospital was replaced, and a replacement hospital for U.C.L.A. Medical Center is almost complete. However, San Francisco General Hospital has been repeatedly identified as vulnerable to destruction in a major quake. The hospital accreditation body should withhold accreditation from hospitals that do not meet 2005 construction standards for windstorm resistance or earthquake resistance (as geographically appropriate).
(2) Develop detailed evacuation plans for hospitals and nursing homes. These should be required by state regulatory authorities, regularly rehearsed, and evaluated during the hospital accreditation process. No patient can be left behind.
(3) Upgrade emergency power generation capabilities, particularly in acute care hospitals. Regulatory standards for location, capacity and operating duration of hospital emergency generators must be updated. I suggest that a one-week emergency power generation capacity for the most critical areas be mandated in acute care hospitals. It seems obvious that modern acute care medicine is power intensive: but patients in New Orleans died when generators did not work or ran out of fuel. It makes no sense to put emergency generators in a basement subject to flooding. Maintenance of air conditioning is vital to patient safety. In New Orleans, patient mortality soared as temperatures in critical care units rose above 100 degrees.
(4) Develop uninterruptible emergency communication systems for disaster. In New Orleans, landline phones, cell phones, and many emergency radios were inoperable. Coordinating life-saving medical care becomes impossible in this setting. It should be a national priority to develop a novel telecommunications solution. In the interim, hospitals and doctors should consider deploying redundant alternative communication devices including satellite and Internet phones.
(5) Consider geographic separation of health care facilities, particularly in areas at high risk for hurricane, earthquake or flooding, to minimize the possibility of a “knock-out” punch to a neighborhood. Avoid constructing new or replacement health care facilities in areas subject to predictable risks such as storm surge or flooding.
(6) Major health care systems should consider developing alternative care sites, which could quickly be opened in emergency situations if primary sites become non-functional. After the September 11th disaster in New York, most major financial institutions developed similar detailed plans and backup facilities.
(7) Mobile health care delivery systems–for instance field hospitals or vans–should be developed for rapid deployment in every region of the country. A number of such systems are successfully being utilized after Hurricane Katrina. These capabilities should be expanded.
(8) Each academic medical center in the United States should develop a partnership arrangement with another academic medical center, to minimize disruption to the education of medical students, residents and fellows during a time of crisis. The value of such a relationship is evident in the relocation of Tulane medical students and residents to Baylor and other facilities in Houston.
Katrinas lessons call for changes that challenge the resolve of our policymakers and the resources of our health care system. Our nation is up to the test.
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