- Email: [email protected]
Providing Healthcare to Evacuees in the Wake of a Natural Disaster: Opportunities to Improve Disaster Planning
Providing Healthcare to Evacuees in the Wake of a Natural Disaster: Opportunities to Improve Disaster Planning JESSICA H. BAILEY, PHD; RICHARD D. DESHAZO, MD
ABSTRACT: Background: The impending landfall of Hurricane Katrina on the Mississippi Gulf Coast resulted in large numbers of evacuees into the Jackson, Mississippi area. Many evacuees with chronic medical problems had been directed to the Mississippi Coliseum in the downtown area near the University of Mississippi Medical Center. As the storm passed through Jackson, serious damage occurred to the municipal infrastructure. In this article, we asked how that experience has affected health planning for the care of sheltered populations. Methods: We reviewed the information accumulated in the course of operating a large medical clinic for evacuees at the Mississippi Coliseum. We also contacted representatives of disaster planning agencies and of healthcare planning organizations to determine changes that have occurred in strategic plans subsequent to Katrina. Results: Using the resources of our
academic health center, we were able to effectively deliver healthcare to sheltered evacuees. A model has been developed for future use from this experience. Much progress has been made toward preparation for care of the chronically-ill who may be displaced by future disasters. Conclusion: Hospitals and clinics on major evacuation routes for natural disasters can expect the sudden necessity to provide care to evacuees. Unless plans to care for chronically-ill individuals are incorporated into hospital disaster plans, local healthcare facilities may be unprepared to provide care. Many evacuees will have limited resources to pay for services. Academic medical centers have unique resources and capabilities to lead in the care plans for these populations. KEY INDEXING TERMS: Emergency preparedness; Chronic disease; Disaster plans. [Am J Med Sci 2008; 336(2):124–127.]
T
ing New Orleans, before landfall. These shelters quickly filled to capacity, housing an average of 1600 individuals per day during the first week after the disaster. The shelters remained open for 19 days. Hurricane Katrina made landfall as a Category 4 storm on the Mississippi Gulf Coast on August 29, 2005 and took a north-easterly course toward Jackson (Photos 3– 6, http://links.lww.com/A489). Katrina reached the city on the afternoon of August 29 with sustained winds of 63 miles per hour. Wind gusts of 84 miles per hour caused damage to homes and businesses with widespread power outages lasting up to 2 weeks in some areas.3,4 Gasoline shortages developed as most service stations were without electrical power, and deliveries of fuel were delayed.5 Within days, local grocery stores experienced shortages of food supplies. A steady stream of evacuees continued to come to the Red Cross Shelter from various locations after learning that they would not be able to return to the Gulf Coast. The Department of Medicine at the University of Mississippi Medical Center learned through patient visits to the University of Mississippi Medical Center Emergency Department that a large number of chronically-ill patients were housed at the Missis-
he Gulf Coast of the United States was aware that a major hurricane, Katrina, would probably make landfall there late in August of 2005. Residents were ordered to evacuate the coastal counties of Mississippi and Louisiana on August 27 to 28. Thousands of evacuees sought shelter in hotels and private homes in the Jackson, Mississippi metropolitan area, 180 miles north of the coastline (Photo 1, http://links.lww.com/A487).1 On August 27, the American Red Cross opened an evacuation shelter on the shared campus of the Mississippi Coliseum (67,140 square feet) and the Mississippi Trade Mart (25,449 square feet) in downtown Jackson (Photo 2, http://links.lww.com/A488).2 Chronically-ill patients, many of whom required nebulized medicines, electrical hook-ups for continuous positive airway pressure and medications were evacuated from coastal Mississippi and Louisiana, includFrom the Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi. Submitted April 29, 2008; accepted in revised form May 23, 2008. Correspondence: Jessica H. Bailey, PhD, Department of Medicine, University of Mississippi Medical Center, Jackson, MS (E-mail: [email protected]).
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sippi Coliseum with no medical care beyond first aid. A healthcare system was quickly put in place for these individuals and has been previously described.5 The purpose of this communication is to provide follow-up on that experience and report subsequent efforts to be better prepared to care for sheltered populations in the future. Methods In preparation of this manuscript, we reviewed the data collected from our free healthcare clinic established at the evacuation shelter on August 30. These include personal recollections and the review of clinic notes, email messages, patient encounter forms, pharmacy records, photographs, newspaper articles, and American Red Cross operational manuals and data. Many but not all of these data were reviewed in the preparation of our earlier report. In addition, we have interviewed individuals who are now in key leadership positions in organizations and agencies responsible for disaster planning and health care in our region. These include the directors of disaster operations for the Mississippi chapter of the American Red Cross and the Mississippi State Health Department, the Clinical Director of Emergency Services and the Emergency Management Coordinator for the University of Mississippi Medical Center and the Director of the Governor’s Task Force for Information Exchange. These individuals were asked to describe the specific changes, innovations or plans developed for medical care of future evacuees subsequent to the Katrina experience.
Results The American Red Cross had a plan in place to house displaced coastal residents in the Mississippi Coliseum and to provide food, mattresses, blankets, other essentials and basic first aid (Photo 7, http://links.lww.com/A490).6 Community volunteers were contacted to establish portable kitchens for cooking and were immediately effective in providing food. In keeping with this plan, the only onsite Red Cross medical personnel were volunteers providing over-the-counter medications to those who sought them. There was no plan of care for evacuees with acute or chronic medical conditions other than to send them to local emergency departments of healthcare facilities in the area. These facilities, for the most part, were operating under disaster plans in preparation to receive large numbers of trauma patients expected from the Gulf Coast and were actively discouraging ambulatory visits. Fortunately, most of the acutely injured storm victims from the Gulf Coast were evacuated east and west to allow our medical center level 1 Trauma Center to care for patients from cities north of the coast that were traversed by the storm after landfall. Disaster plans previously developed at the 5 other local hospitals and the Medical Center were designed in preparation for mass casualty (airplane or train crashes) or bioterrorism, disasters that would create the need for emergent care of acute injuries. There were no plans or resources in place to prepare for the care of large numbers of ambulatory disTHE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
placed patients with chronic medical conditions who, more often than not, had no healthcare insurance and little financial where-with-all. Our previous report documented that two-thirds of individuals sheltered at the Mississippi Coliseum had no insurance.5 Because they left their homes near the end of the month, few of these patients had money to purchase medications. Moreover, local banks were closed, charge cards were not functional, physicians’ offices were not open, telephones and cell phones did not work, gasoline was not available, and many medical personnel were at home without electrical power dealing with family needs since schools were closed. Learning that large numbers of chronically-ill evacuees were being housed just 3 miles from our Medical Center and were beginning to stream into the local emergency rooms, The Department of Medicine called a meeting to initiate a response to this situation. A physician team was dispatched to the Red Cross shelter to evaluate needs and available resources. The team determined that there was an urgent need for medical services and obtained permission from the shelter supervisor to begin setting up a free clinic. With the approval of the Red Cross and state officials, a physician experienced in public health was appointed by the department chair to serve as medical director of the free clinic. A faculty clinical pharmacist with experience in medical missions was appointed to establish a system to dispense medications, and an administrator with experience in clinical services was appointed as administrator of the shelter clinic. Volunteers With widespread telephone and cell phone outages because of damaged towers and downed telephone poles, email within the medical center system was used initially to recruit volunteers. An administrative assistant was tasked with compiling a potential volunteer list, categorized by profession and contact information. Over 375 volunteers were recruited and mobilized for work in the clinic. Meetings were conducted with the staff each day before the clinic opened and after closing to assess the changing needs of the patient population. The clinic was open to see patients for 3 hours a day or until their needs were met. Volunteer providers were required to have active medical licensure or be enrolled trainees at the medical center. A few licensed out-of-state physicians and nurses were later included as volunteers, as allowed by state law in emergency situations.7 Clinic directors were appointed in adult, pediatric, pharmacy, nursing, and administrative services. They identified individuals to coordinate and supervise volunteers in these areas. As the clinic continued to operate, it was apparent that special needs were present in allergy (asthma), psychiatry, obstetrics, 125
Healthcare to Evacuees in the Wake of a Natural Disaster
Figure 1. Organizational chart.
dentistry, oncology, chronic renal failure, and other specialized areas. Clinical volunteers were then recruited in these areas, and care was provided (Figure 1). Daily Operations The healthcare clinic at the evacuation shelter was staffed from August 30 until September 17, 2005 to provide free care to the evacuees at the Mississippi Coliseum and in the Jackson metropolitan area (Photo 8, http://links.lww.com/A491). The Red Cross originally allocated 3447 square feet for clinic space which was curtained off from the living space for evacuees. A large recreational vehicle loaned by the University of Mississippi Medical Center School of Nursing housed the pharmacy until a more secure space at the shelter was identified (Photo 9, http://links.lww.com/A492). How long the shelter would be required was unclear, so administrative leaders developed functional job titles and job descriptions along with a list of prospective volunteers to keep the clinic operational for an indefinite time. Medical Center leadership also secured a gasoline supply from another region and set up a temporary fueling station for University employees. A temporary daycare was also set up for University employees’ children, since most daycares and schools remained closed. Many University employees volunteered before and after their regular shifts. An urgent need for record keeping in the clinic became apparent and resulted in the creation of a paper encounter form. Although 2394 patients were seen in the clinic, only 2299 patient records were available for analysis. Data from these records allowed accumulation of some demographic data. The average patient was 40.6 years old, most of the patients were African-American and 62% were female. Although the shelter population fluctuated on a daily basis, this had little effect on the number of patients seen in the clinic. The clinic patient popu126
lation remained constant at approximately 150 patients each day. Patients coming to the Katrina Clinic needed medications. Most of the evacuees had left their homes with the assumption that they would return in 24 to 48 hours. A quick assessment of medication needs, prescription writing, identification of the few pharmacies that were open, and location of medications for the evacuees who were unable to pay for them was made. Using sample drugs obtained from pharmaceutical companies and physician offices, a temporary medication refill station was opened on the main campus of the University Medical Center on August 30 and within 24 hours relocated to the shelter site. The pharmacy at the evacuee shelter was open for 17 days and filled in excess of 4902 prescriptions. Subsequently, local retail pharmacies also assisted in providing needed medications. Within a week, Wal-Mart and Walgreen Pharmacies provided pharmacists at the shelter clinic. When the clinic did not have the appropriate medication, their representatives received prescriptions written for evacuees, filled them at a local retail site, and delivered them back to the shelter at minimal or no cost to the evacuees. Preparation for Future Disaster Disaster management and emergency medical services are components of the Governor’s Emergency Management Plan in Mississippi.8 This plan uses a “bottom-up” approach with local, regional, state (Mississippi Emergency Management Agency) and national (Federal Emergency Management Agency) activation of resources as the capabilities of each preceding level are exceeded. Mississippi’s Emergency Management Plan has been in ongoing revision since Katrina. The Mississippi State Department of Health has been charged with developing resources for individuals with special medical needs who require evacuation from the Mississippi Gulf Coast or elsewhere during future hurricanes or August 2008 Volume 336 Number 2
Bailey and Deshazo
other disasters. Shelters for individuals with special medical needs have now been established and outfitted with electrical generators, air conditioning, portable hospital beds and basic medical supplies at 7 community colleges in south and south-central Mississippi below United States Interstate 20. Arrangements have also been made for food services, security, wireless communication, and telemedicine services to the University Medical Center to support these shelters. A District Public Health Officer is now responsible for each of the special needs shelters, presently capable of sheltering a total of 1300 patients. The plan requires the shelters to be operational within 12 hours of activation by the Mississippi Emergency Management Agency. Plans are underway to develop a similar program for areas of the State north of Interstate 20. These regional special medical needs shelters are in addition to local county special medical needs shelters and shelters for the general public which will be operated in collaboration with the Mississippi Department of Health Services and volunteer agencies including the American Red Cross. The Mississippi State Department of Health has also acquired 3, 50-bed portable field hospitals to be used for triages, medical care or shelter. Most of the hospitals throughout the state have now been furnished with wireless communication systems including satellite push-to-talk radios and telephones. Finally, a web-based system, SMARTT (State Medical Asset Resource Tracking Tool) has been created to accurately identify resources available in facilities within the state, including physicians, nurses, beds, medications, and other medical equipment so that efficient routing and movement of patients after a disaster may occur. An additional database has been established to register providers by category relating to training and expertise. An electronic system is planned to provide access to an individual’s health history and medical information through a data exchange mechanism. Discussion Most evacuees who came to the Jackson area before Katrina had resources, did not stay in shelters and were not in need of acute healthcare. They typically waited in hotels or private homes until the local situation stabilized, and then, if needed, sought medical care in private clinics. Many of the initial patients we encountered at the shelter in Jackson had evacuated or been evacuated from coastal areas because of the need for ongoing healthcare for chronic medical conditions. Our shelter clinic was established to provide medical care for those adults and children who did not have resources for stays in hotels or motels or health insur-
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
ance to access care in the private medical community. The greatest challenges to effectiveness of our efforts were communication systems, fuel for health care providers, systems for capturing and maintaining health information and procurement of medications, medical devices, and equipment. In the original analysis of our Katrina experience, we suggested that state, regional, and local hospital disaster plans should address support of displaced individuals with chronic illness, as well as those with acute injuries after natural disaster(s). Provision for ambulatory care in close proximity to evacuees put in place in advance of their arrival was also recommended. Progress has been made in this area by the establishment of local special needs shelters in addition to shelters for the general public. However, healthcare facilities and professionals along potential evacuation routes should assume that they may be called upon to care for evacuee populations in the future. Thus, plans for care of these patients should be incorporated into institutional disaster plans. Academic health centers have unique resources to provide leadership in this effort and are encouraged to be proactive in the development of contingencies for these events. Acknowledgments The authors thank Leigh Wright, BA, for her assistance with the preparation of the manuscript. Mary Currier, MD, MPH, Marion Wofford, MD, MPH, Deborah S. King Minor, PharmD, Bethany J. Daniel, BS and a host of other volunteers from the University of Mississippi Medical Center that made our efforts and this paper possible. References 1. National Weather Service Forecast Office. A look at Hurricane Katrina. Available at: http://www.srh.noaa.gov/jan/Katrina. Accessed March 21, 2008. 2. Mississippi Emergency Management Agency. Mississippians urged to take precautions for Hurricane Katrina. August 28, 2005. Available at: http://www.msema.org/newsrealeases/documents/ Katrina8.28.05.doc. 3. Valcourt J. Katrina’s fatal blow. Clarion Ledger [serial online: Available at: http://www.clarionledger.com/] September 1, 2005;9A. Accessed March 21, 2008. 4. Lindsay A. Hurricane Katrina. Clarion Ledger [serial online: Available at: http://www.clarionledger.com/] September 6, 2005;1B. Accessed March 21, 2008. 5. Currier M, King D, Wofford M, et al. A Katrina experience: lessons learned. Am J Med 2006;119:986 –92. 6. American Red Cross. Disaster Health Services ARC 30-3042 1998;16. 7. Mississippi Code of 1972 as amended, Emergency Management Assistance Compact of 2000, Title 45, Chapter 18-3, Article 5. April 17, 2000. 8. Mississippi Code of 1972 as amended, Emergency Management Powers of Governor, Title 33, Chapter 15-11. March 20, 2006.
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ABSTRACT: Background: The impending landfall of Hurricane Katrina on the Mississippi Gulf Coast resulted in large numbers of evacuees into the Jackson, Mississippi area. Many evacuees with chronic medical problems had been directed to the Mississippi Coliseum in the downtown area near the University of Mississippi Medical Center. As the storm passed through Jackson, serious damage occurred to the municipal infrastructure. In this article, we asked how that experience has affected health planning for the care of sheltered populations. Methods: We reviewed the information accumulated in the course of operating a large medical clinic for evacuees at the Mississippi Coliseum. We also contacted representatives of disaster planning agencies and of healthcare planning organizations to determine changes that have occurred in strategic plans subsequent to Katrina. Results: Using the resources of our
academic health center, we were able to effectively deliver healthcare to sheltered evacuees. A model has been developed for future use from this experience. Much progress has been made toward preparation for care of the chronically-ill who may be displaced by future disasters. Conclusion: Hospitals and clinics on major evacuation routes for natural disasters can expect the sudden necessity to provide care to evacuees. Unless plans to care for chronically-ill individuals are incorporated into hospital disaster plans, local healthcare facilities may be unprepared to provide care. Many evacuees will have limited resources to pay for services. Academic medical centers have unique resources and capabilities to lead in the care plans for these populations. KEY INDEXING TERMS: Emergency preparedness; Chronic disease; Disaster plans. [Am J Med Sci 2008; 336(2):124–127.]
T
ing New Orleans, before landfall. These shelters quickly filled to capacity, housing an average of 1600 individuals per day during the first week after the disaster. The shelters remained open for 19 days. Hurricane Katrina made landfall as a Category 4 storm on the Mississippi Gulf Coast on August 29, 2005 and took a north-easterly course toward Jackson (Photos 3– 6, http://links.lww.com/A489). Katrina reached the city on the afternoon of August 29 with sustained winds of 63 miles per hour. Wind gusts of 84 miles per hour caused damage to homes and businesses with widespread power outages lasting up to 2 weeks in some areas.3,4 Gasoline shortages developed as most service stations were without electrical power, and deliveries of fuel were delayed.5 Within days, local grocery stores experienced shortages of food supplies. A steady stream of evacuees continued to come to the Red Cross Shelter from various locations after learning that they would not be able to return to the Gulf Coast. The Department of Medicine at the University of Mississippi Medical Center learned through patient visits to the University of Mississippi Medical Center Emergency Department that a large number of chronically-ill patients were housed at the Missis-
he Gulf Coast of the United States was aware that a major hurricane, Katrina, would probably make landfall there late in August of 2005. Residents were ordered to evacuate the coastal counties of Mississippi and Louisiana on August 27 to 28. Thousands of evacuees sought shelter in hotels and private homes in the Jackson, Mississippi metropolitan area, 180 miles north of the coastline (Photo 1, http://links.lww.com/A487).1 On August 27, the American Red Cross opened an evacuation shelter on the shared campus of the Mississippi Coliseum (67,140 square feet) and the Mississippi Trade Mart (25,449 square feet) in downtown Jackson (Photo 2, http://links.lww.com/A488).2 Chronically-ill patients, many of whom required nebulized medicines, electrical hook-ups for continuous positive airway pressure and medications were evacuated from coastal Mississippi and Louisiana, includFrom the Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi. Submitted April 29, 2008; accepted in revised form May 23, 2008. Correspondence: Jessica H. Bailey, PhD, Department of Medicine, University of Mississippi Medical Center, Jackson, MS (E-mail: [email protected]).
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sippi Coliseum with no medical care beyond first aid. A healthcare system was quickly put in place for these individuals and has been previously described.5 The purpose of this communication is to provide follow-up on that experience and report subsequent efforts to be better prepared to care for sheltered populations in the future. Methods In preparation of this manuscript, we reviewed the data collected from our free healthcare clinic established at the evacuation shelter on August 30. These include personal recollections and the review of clinic notes, email messages, patient encounter forms, pharmacy records, photographs, newspaper articles, and American Red Cross operational manuals and data. Many but not all of these data were reviewed in the preparation of our earlier report. In addition, we have interviewed individuals who are now in key leadership positions in organizations and agencies responsible for disaster planning and health care in our region. These include the directors of disaster operations for the Mississippi chapter of the American Red Cross and the Mississippi State Health Department, the Clinical Director of Emergency Services and the Emergency Management Coordinator for the University of Mississippi Medical Center and the Director of the Governor’s Task Force for Information Exchange. These individuals were asked to describe the specific changes, innovations or plans developed for medical care of future evacuees subsequent to the Katrina experience.
Results The American Red Cross had a plan in place to house displaced coastal residents in the Mississippi Coliseum and to provide food, mattresses, blankets, other essentials and basic first aid (Photo 7, http://links.lww.com/A490).6 Community volunteers were contacted to establish portable kitchens for cooking and were immediately effective in providing food. In keeping with this plan, the only onsite Red Cross medical personnel were volunteers providing over-the-counter medications to those who sought them. There was no plan of care for evacuees with acute or chronic medical conditions other than to send them to local emergency departments of healthcare facilities in the area. These facilities, for the most part, were operating under disaster plans in preparation to receive large numbers of trauma patients expected from the Gulf Coast and were actively discouraging ambulatory visits. Fortunately, most of the acutely injured storm victims from the Gulf Coast were evacuated east and west to allow our medical center level 1 Trauma Center to care for patients from cities north of the coast that were traversed by the storm after landfall. Disaster plans previously developed at the 5 other local hospitals and the Medical Center were designed in preparation for mass casualty (airplane or train crashes) or bioterrorism, disasters that would create the need for emergent care of acute injuries. There were no plans or resources in place to prepare for the care of large numbers of ambulatory disTHE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
placed patients with chronic medical conditions who, more often than not, had no healthcare insurance and little financial where-with-all. Our previous report documented that two-thirds of individuals sheltered at the Mississippi Coliseum had no insurance.5 Because they left their homes near the end of the month, few of these patients had money to purchase medications. Moreover, local banks were closed, charge cards were not functional, physicians’ offices were not open, telephones and cell phones did not work, gasoline was not available, and many medical personnel were at home without electrical power dealing with family needs since schools were closed. Learning that large numbers of chronically-ill evacuees were being housed just 3 miles from our Medical Center and were beginning to stream into the local emergency rooms, The Department of Medicine called a meeting to initiate a response to this situation. A physician team was dispatched to the Red Cross shelter to evaluate needs and available resources. The team determined that there was an urgent need for medical services and obtained permission from the shelter supervisor to begin setting up a free clinic. With the approval of the Red Cross and state officials, a physician experienced in public health was appointed by the department chair to serve as medical director of the free clinic. A faculty clinical pharmacist with experience in medical missions was appointed to establish a system to dispense medications, and an administrator with experience in clinical services was appointed as administrator of the shelter clinic. Volunteers With widespread telephone and cell phone outages because of damaged towers and downed telephone poles, email within the medical center system was used initially to recruit volunteers. An administrative assistant was tasked with compiling a potential volunteer list, categorized by profession and contact information. Over 375 volunteers were recruited and mobilized for work in the clinic. Meetings were conducted with the staff each day before the clinic opened and after closing to assess the changing needs of the patient population. The clinic was open to see patients for 3 hours a day or until their needs were met. Volunteer providers were required to have active medical licensure or be enrolled trainees at the medical center. A few licensed out-of-state physicians and nurses were later included as volunteers, as allowed by state law in emergency situations.7 Clinic directors were appointed in adult, pediatric, pharmacy, nursing, and administrative services. They identified individuals to coordinate and supervise volunteers in these areas. As the clinic continued to operate, it was apparent that special needs were present in allergy (asthma), psychiatry, obstetrics, 125
Healthcare to Evacuees in the Wake of a Natural Disaster
Figure 1. Organizational chart.
dentistry, oncology, chronic renal failure, and other specialized areas. Clinical volunteers were then recruited in these areas, and care was provided (Figure 1). Daily Operations The healthcare clinic at the evacuation shelter was staffed from August 30 until September 17, 2005 to provide free care to the evacuees at the Mississippi Coliseum and in the Jackson metropolitan area (Photo 8, http://links.lww.com/A491). The Red Cross originally allocated 3447 square feet for clinic space which was curtained off from the living space for evacuees. A large recreational vehicle loaned by the University of Mississippi Medical Center School of Nursing housed the pharmacy until a more secure space at the shelter was identified (Photo 9, http://links.lww.com/A492). How long the shelter would be required was unclear, so administrative leaders developed functional job titles and job descriptions along with a list of prospective volunteers to keep the clinic operational for an indefinite time. Medical Center leadership also secured a gasoline supply from another region and set up a temporary fueling station for University employees. A temporary daycare was also set up for University employees’ children, since most daycares and schools remained closed. Many University employees volunteered before and after their regular shifts. An urgent need for record keeping in the clinic became apparent and resulted in the creation of a paper encounter form. Although 2394 patients were seen in the clinic, only 2299 patient records were available for analysis. Data from these records allowed accumulation of some demographic data. The average patient was 40.6 years old, most of the patients were African-American and 62% were female. Although the shelter population fluctuated on a daily basis, this had little effect on the number of patients seen in the clinic. The clinic patient popu126
lation remained constant at approximately 150 patients each day. Patients coming to the Katrina Clinic needed medications. Most of the evacuees had left their homes with the assumption that they would return in 24 to 48 hours. A quick assessment of medication needs, prescription writing, identification of the few pharmacies that were open, and location of medications for the evacuees who were unable to pay for them was made. Using sample drugs obtained from pharmaceutical companies and physician offices, a temporary medication refill station was opened on the main campus of the University Medical Center on August 30 and within 24 hours relocated to the shelter site. The pharmacy at the evacuee shelter was open for 17 days and filled in excess of 4902 prescriptions. Subsequently, local retail pharmacies also assisted in providing needed medications. Within a week, Wal-Mart and Walgreen Pharmacies provided pharmacists at the shelter clinic. When the clinic did not have the appropriate medication, their representatives received prescriptions written for evacuees, filled them at a local retail site, and delivered them back to the shelter at minimal or no cost to the evacuees. Preparation for Future Disaster Disaster management and emergency medical services are components of the Governor’s Emergency Management Plan in Mississippi.8 This plan uses a “bottom-up” approach with local, regional, state (Mississippi Emergency Management Agency) and national (Federal Emergency Management Agency) activation of resources as the capabilities of each preceding level are exceeded. Mississippi’s Emergency Management Plan has been in ongoing revision since Katrina. The Mississippi State Department of Health has been charged with developing resources for individuals with special medical needs who require evacuation from the Mississippi Gulf Coast or elsewhere during future hurricanes or August 2008 Volume 336 Number 2
Bailey and Deshazo
other disasters. Shelters for individuals with special medical needs have now been established and outfitted with electrical generators, air conditioning, portable hospital beds and basic medical supplies at 7 community colleges in south and south-central Mississippi below United States Interstate 20. Arrangements have also been made for food services, security, wireless communication, and telemedicine services to the University Medical Center to support these shelters. A District Public Health Officer is now responsible for each of the special needs shelters, presently capable of sheltering a total of 1300 patients. The plan requires the shelters to be operational within 12 hours of activation by the Mississippi Emergency Management Agency. Plans are underway to develop a similar program for areas of the State north of Interstate 20. These regional special medical needs shelters are in addition to local county special medical needs shelters and shelters for the general public which will be operated in collaboration with the Mississippi Department of Health Services and volunteer agencies including the American Red Cross. The Mississippi State Department of Health has also acquired 3, 50-bed portable field hospitals to be used for triages, medical care or shelter. Most of the hospitals throughout the state have now been furnished with wireless communication systems including satellite push-to-talk radios and telephones. Finally, a web-based system, SMARTT (State Medical Asset Resource Tracking Tool) has been created to accurately identify resources available in facilities within the state, including physicians, nurses, beds, medications, and other medical equipment so that efficient routing and movement of patients after a disaster may occur. An additional database has been established to register providers by category relating to training and expertise. An electronic system is planned to provide access to an individual’s health history and medical information through a data exchange mechanism. Discussion Most evacuees who came to the Jackson area before Katrina had resources, did not stay in shelters and were not in need of acute healthcare. They typically waited in hotels or private homes until the local situation stabilized, and then, if needed, sought medical care in private clinics. Many of the initial patients we encountered at the shelter in Jackson had evacuated or been evacuated from coastal areas because of the need for ongoing healthcare for chronic medical conditions. Our shelter clinic was established to provide medical care for those adults and children who did not have resources for stays in hotels or motels or health insur-
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
ance to access care in the private medical community. The greatest challenges to effectiveness of our efforts were communication systems, fuel for health care providers, systems for capturing and maintaining health information and procurement of medications, medical devices, and equipment. In the original analysis of our Katrina experience, we suggested that state, regional, and local hospital disaster plans should address support of displaced individuals with chronic illness, as well as those with acute injuries after natural disaster(s). Provision for ambulatory care in close proximity to evacuees put in place in advance of their arrival was also recommended. Progress has been made in this area by the establishment of local special needs shelters in addition to shelters for the general public. However, healthcare facilities and professionals along potential evacuation routes should assume that they may be called upon to care for evacuee populations in the future. Thus, plans for care of these patients should be incorporated into institutional disaster plans. Academic health centers have unique resources to provide leadership in this effort and are encouraged to be proactive in the development of contingencies for these events. Acknowledgments The authors thank Leigh Wright, BA, for her assistance with the preparation of the manuscript. Mary Currier, MD, MPH, Marion Wofford, MD, MPH, Deborah S. King Minor, PharmD, Bethany J. Daniel, BS and a host of other volunteers from the University of Mississippi Medical Center that made our efforts and this paper possible. References 1. National Weather Service Forecast Office. A look at Hurricane Katrina. Available at: http://www.srh.noaa.gov/jan/Katrina. Accessed March 21, 2008. 2. Mississippi Emergency Management Agency. Mississippians urged to take precautions for Hurricane Katrina. August 28, 2005. Available at: http://www.msema.org/newsrealeases/documents/ Katrina8.28.05.doc. 3. Valcourt J. Katrina’s fatal blow. Clarion Ledger [serial online: Available at: http://www.clarionledger.com/] September 1, 2005;9A. Accessed March 21, 2008. 4. Lindsay A. Hurricane Katrina. Clarion Ledger [serial online: Available at: http://www.clarionledger.com/] September 6, 2005;1B. Accessed March 21, 2008. 5. Currier M, King D, Wofford M, et al. A Katrina experience: lessons learned. Am J Med 2006;119:986 –92. 6. American Red Cross. Disaster Health Services ARC 30-3042 1998;16. 7. Mississippi Code of 1972 as amended, Emergency Management Assistance Compact of 2000, Title 45, Chapter 18-3, Article 5. April 17, 2000. 8. Mississippi Code of 1972 as amended, Emergency Management Powers of Governor, Title 33, Chapter 15-11. March 20, 2006.
127