katrina 8 years later: have we kyle f. dickson, m.d. m.b.a
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90.04.32w29.57.18n
Planning forDisaster Management
Lessons learned Katrina, Rita, Ike and
Gustav
Norman McSwain , MDProfessor of SurgeryTulane UniversityTrauma director
Spirit of Charity Trauma CenterMedical Director
PreHospital Trauma Life Support
Kyle F. Dickson, M.D. M.B.A.
Professor Baylor College of MedicineSouthwest Orthopaedic Group, Houston, Texas
[email protected] cell 713-208-4168
Katrina 8 Years Later: Have We Learned Anything Yet?
Kyle Dickson MD, MBAProfessor of Orthopaedics Baylor College of Medicine
Southwest Orthopaedic Group
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Summary•Proper emergency management planning (Get Involved-ask?)–Food, water, generators, personnel,
patient evacuations •Military
–Security–Communications
Kyle F. Dickson, M.D.Professor and
Director of Orthopaedic Trauma,Tulane University
Chief of Orthopaedics, Charity HospitalClinical Assistant Professor, LSU
Disaster (sudden onset of unexpected circumstances)
•Natural (hurricane, earthquake, etc)•Mechanical (bus rollover, tanker hitting casino, multi vehicle collisions, explosions, wind, etc.)•Biochemical (government most concerned)
“Explosions and bombings remain the most common deliberate cause of
disasters involving large numbers of casualties'”
Sherma, Am J disaster Med2008
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Beautiful Lakeview House for Sale
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New Orleans HurricanesAugust 1779
Lessons learned from ground zero
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“New Orleans has dodged a bullet”
90.04.32w29.57.18n Wind
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WindHurricane Mark Twain 1883
• “There is nothing but that frail breastwork of earth between the people and destruction”
9:50am Monday August 29, 2005
Surge >50 feet, Lake Ponchartrain elevated 15 feet 18th Street Canal
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Levee Breaks
Before After
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Industrial Canal Break FloodWater comes and stays
Charity HospitalTulane
After
VA
University Hospital
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80% of the city was underwater 90%of the homes
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On the Streets
A diabetic
Prisoners on the Interstate
Days without water or food while the world
watched and FEMA trucks drove by
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Canal St.
Six Flags -- Jazzland Power
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PowerEmergency (generator ) power (24 hours vs 80 hours, basement)•Red plugs•Ventilators, Operating Room, Selected lights•EMR, Radiology, Lab, Pharmacy, Communication
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Lesson 1•Proper Emergency planning–Worst case scenario planning (Munich –F.E.M.A.)–Hundreds of school buses underwater (use of resources)
Lesson 1–Common sense construction (generators in the basement or filled on the first floor, fuel two blocks away -80 hours)–Triage (who lives and who dies)
Planning and ManagementProblems
Inappropriate planningnot
mistakes in field-level decision makingSuccesses
Initiatives in front line medics compensated for lack of clear command
by senior managersCritical thinking by field personnel
CarresiDisaster 2008
Madrid bombing
Response• Immediate
– 2-5 days– Local resources only– Preparation– Storage– Communication– Command & control– Security– Evacuation
SanitationWater
Kitty literDisposal bags
Cleanser
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Toilet paper…Check Bud Light…Check Keystone Ice…CheckBudweiser…Check Red Dog…Check
Misc. Other bottles of Alcohol…CheckPiece of Plywood to Float Your Chick and Booze on…Check
NEXT TIME, LET’S ALL BE BETTER PREPARED
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Lesson 2•Security is number one issue–Lawless society (superdome – rape, murder, pillaging, vandalism, etc.)–Military presence ASAP ( “national valued asset”)–Hospital lockdown (inundated with health care providers 4-5/1)
In a grab and run test, Heineken was the number one choice of beer for looters in the New Orleans metropolitan area. When asked,
most agreed that Colt 45 or Red Dog was their main beer of purchase, but when money doesn’t matter,
they grab for the finest beer around, Heineken.
Thank you, New Orleans, for making us number one.
Response
Reliable communication – Satellite phones (Ham radio system)
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Response• Immediate
– 2-5 days– Local resources only– Preparation– Storage– Communication– Command & control– Security– Evacuation (planned arrangements)
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Hemingway called courage “grace under pressure”
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Lesson 3•Communications–Between hospital and helicopters (other hospitals or the outside world)–Military –Orthopedic surgeons should be in charge (a lot less “dickin around”)
Response• Immediate
– 2-5 days– Local resources only– Preparation– Storage– Communication– Command & control– Security– Evacuation
Towers down or damagedBatteries run out
without recharging
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“Lagniappe (spanish) …is the equivalent of the thirteenth roll in a “baker’s dozen”
Mark Twain
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A beached boat on Napoleon?
Fats Domino’s Living Room(The Fat Man – “Bluberry Hill”)
Before
After
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Individual Lessons•The water was toxic (admitted with sepsis)•The water didn’t just come and go but stayed for 4 weeks • Insurance companies are crooks (maximum allowable flood only 1/3 cost of the house – no home owners)
Long Black LineSpencer Bohrren
Rescue evacuation
1300 found in the attic
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Debris
34 Normal Years of
Garbage in 3 Months
Myths of disaster managementI’m from the government I am here to help you
You are on your own for 72 hoursThere is no help
Hurricanes Gustav and Ike• A new challenge – two hurricanes – two coasts - back to back• Orleans Parish hospitals evacuate pre-storm– LSU evacuated to other LSU hospitals– Tulane evacuates to other HCA hospitals– Ochsner Baptist evacuates to other
Ochsner hospitals
Command and Control• Most important change from Katrina to Gustav• Coordinated command and control• Leadership• Power and control• Private (HCA) and Public ( Charity) worked• Government system (FEMA) did not work
We must fend for ourselvesThe government is NOT here to help
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Disaster aftermathThe US Third World
Human Resources• Medical• Administration• Infrastructure workers• Fatigue• Shift work
Non Human Resources• Power
– Electricity– Gas
• Water– Potable– Non Potable
• Sanitation• Food• Medication• Equipment• Supplies• Communication• Transportation
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My Plea•Get involved! Orthopaedist are needed (IGOT-OTI)–Hospital emergency preparedness–Third World volunteerism
�Time�Money�Sponsorship
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Summary•Proper emergency management planning (Get Involved)–Food, water, generators, personnel,
patient evacuations, family•Military
–Security–Communications
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New Orleans 2 Years Later• Minimal Rebuilding in Lakeview• No guarantee levee can with stand level 5 hurricane• Insurance paid one third of the cost of the house• ? Return of the “Soul” of New Orleans
Year 2 “I Wish I …”• Backed up thousands of patients in research studies• Taken a greater role in Emergency Management for the hospital (satellite communications, evacuation plans, power, water, security, and staffing)• Personal emergency preparedness
What I Wish I Knew•Planning (2-3 days to prepare not plan)• Indentification/Badge for disaster•Water/Food•Family safe•Communication (satellite phones, ham radios)
Guilty•Ran form New Orleans, ran from Baton Rouge to Houston–Appreciation for my patients
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Guilty�“finddoctordickson.com”�Nice to see friendly faces in hostile lands
–Art of medicine (not the business or science of medicine)
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Studs Terkel wrote, “Hope has never trickled down. It
has always sprung up”
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“Let the city return to the swamp”• Music – The beginnings of Jazz, Blues, Zydeco, Gospel, Cajun and Creole (Louis Armstrong “What a Wonderful World”,Fats “Blueberry Hill”, Aaron Neville “Louisiana 1927”) • Food – The amalgamation of all countries of the world
The sounds and the flavors that are yet to be created
Although a third of the population lived below the poverty line, a culture of free and collective amusement has
emerged
Mardi Gras 2009• 1699 French explorer Iberville• ?Largest preplanned disaster in the U.S. (maybe world)•Population 350,000 to 10 million over 2 weeks
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Final Lesson• The best and the worst of humanity•What really is Important
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Thank You