Katrina 8 Years Later: Have We Kyle F. Dickson, M.D. M.B.A. - PowerPoint PPT Presentation

Planning for Disaster Management 90.04.32w 29.57.18n Norman McSwain , MD Lessons learned Professor of Surgery Tulane University Katrina, Rita, Ike and Trauma director Spirit of Charity Trauma Center Gustav Medical Director PreHospital Trauma Life Support Katrina 8 Years Later: Have We Kyle F. Dickson, M.D. M.B.A. Learned Anything Yet? Professor Baylor College of Medicine Southwest Orthopaedic Group, Houston, Texas Kyle Dickson MD, MBA kyledickson99@gmail.com cell 713-208-4168 Professor of Orthopaedics Baylor College of Medicine Southwest Orthopaedic Group 1

Summary Kyle F. Dickson, M.D. • Proper emergency management planning (Get Involved-ask?) Professor and Director of Orthopaedic Trauma, –Food, water, generators, personnel, patient evacuations Tulane University Chief of Orthopaedics, Charity Hospital • Military Clinical Assistant Professor, LSU –Security –Communications Disaster (sudden onset of unexpected circumstances) “ Explosions and bombings remain the • Natural (hurricane, earthquake, etc) most common deliberate cause of • Mechanical (bus rollover, tanker disasters involving large numbers of hitting casino, multi vehicle collisions, casualties' ” explosions, wind, etc.) • Biochemical (government most Sherma, Am J disaster Med concerned) 2008 2

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Beautiful Lakeview House for Sale 4

New Orleans Hurricanes August 1779 Lessons learned from ground zero 5

“ New Orleans has dodged a bullet ” 90.04.32w Wind 29.57.18n 6

Wind Mark Twain 1883 Hurricane • “There is nothing but that frail breastwork of earth between the people and destruction” 9:50am Monday August 29, 2005 18 th Street Canal Surge >50 feet, Lake Ponchartrain elevated 15 feet 7

Levee Breaks After Before 8

Industrial Canal Break Flood Water comes and stays Tulane University Charity Hospital Hospital VA After 9

80% of the city was underwater 90%of the homes 10

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On the Streets Prisoners on the Interstate A diabetic Days without water or food while the world watched and FEMA trucks drove by 13

Canal St. Six Flags -- Jazzland Power 14

Power Emergency (generator ) power (24 hours vs 80 hours, basement) • Red plugs • Ventilators, Operating Room, Selected lights • EMR, Radiology, Lab, Pharmacy, Communication 15

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Lesson 1 Lesson 1 • Proper Emergency planning –Common sense construction (generators in the basement or filled –Worst case scenario planning on the first floor, fuel two blocks (Munich –F.E.M.A.) away -80 hours) –Hundreds of school buses –Triage (who lives and who dies) underwater (use of resources) Planning and Management Response Sanitation Problems Carresi Water Disaster 2008 • Immediate Madrid bombing Kitty liter Inappropriate planning Disposal bags – 2-5 days Cleanser not – Local resources only mistakes in field-level decision making – Preparation Successes – Storage Initiatives in front line medics – Communication compensated for lack of clear command – Command & control by senior managers – Security Critical thinking by field personnel – Evacuation 17

NEXT TIME, LET’S ALL BE BETTER PREPARED Toilet paper…Check Bud Light…Check Keystone Ice…Check Budweiser…Check Red Dog…Check Misc. Other bottles of Alcohol…Check Piece of Plywood to Float Your Chick and Booze on…Check 18

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) Response 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. Reliable communication – Satellite phones (Ham radio system) Thank you, New Orleans, for making us number one. 19

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Response • Immediate – 2-5 days – Local resources only – Preparation – Storage – Communication – Command & control – Security – Evacuation (planned arrangements) 21

Hemingway called courage “grace under pressure” 22

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Lesson 3 Response • Communications • Immediate Towers down or damaged –Between hospital and helicopters – 2-5 days Batteries run out (other hospitals or the outside world) without recharging – Local resources only –Military – Preparation – Storage –Orthopedic surgeons should be in – Communication charge (a lot less “dickin around”) – Command & control – Security – Evacuation 24

“Lagniappe (spanish) …is the equivalent of the thirteenth roll in a “baker’s dozen” Mark Twain 25

A beached boat on Napoleon? Fats Domino’s Living Room (The Fat Man – “Bluberry Hill”) Before After 26

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 Line Spencer Bohrren Rescue evacuation 1300 found in the attic 27

Myths Debris of disaster management I’m from the government I am here to help you You are on your own for 72 hours 34 Normal There is no help Years of Garbage in 3 Months Hurricanes Gustav and Ike Command and Control • Most important change from Katrina to • A new challenge – two hurricanes – two Gustav coasts - back to back • Coordinated command and control We must fend for ourselves • Orleans Parish hospitals evacuate pre- The government is NOT here to help • Leadership storm • Power and control – LSU evacuated to other LSU hospitals • Private (HCA) and Public ( Charity) worked – Tulane evacuates to other HCA hospitals – Ochsner Baptist evacuates to other • Government system (FEMA) did not work Ochsner hospitals 28

Disaster aftermath The US Third World Non Human Resources Power • Human Resources – Electricity – Gas Medical • Water Administration • • Infrastructure workers – Potable • – Non Potable Fatigue • Sanitation Shift work • • Food • Medication • Equipment • Supplies • Communication • Transportation • 29

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My Plea • Get involved! Orthopaedist are needed (IGOT-OTI) –Hospital emergency preparedness –Third World volunteerism � Time � Money � Sponsorship 31

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Summary • Proper emergency management planning (Get Involved) –Food, water, generators, personnel, patient evacuations, family • Military –Security –Communications 33

New Orleans 2 Years Later Year 2 “I Wish I …” • Backed up thousands of patients in research • Minimal Rebuilding in Lakeview studies • No guarantee levee can with stand level • Taken a greater role in Emergency 5 hurricane Management for the hospital (satellite • Insurance paid one third of the cost of communications, evacuation plans, power, the house water, security, and staffing) • ? Return of the “Soul” of New Orleans • Personal emergency preparedness Guilty What I Wish I Knew • Planning (2-3 days to prepare not • Ran form New Orleans, ran from plan) Baton Rouge to Houston • Indentification/Badge for disaster –Appreciation for my patients • Water/Food • Family safe • Communication (satellite phones, ham radios) 34

Guilty � “finddoctordickson.com” � Nice to see friendly faces in hostile lands –Art of medicine (not the business or science of medicine) 35

Studs Terkel wrote, “Hope has never trickled down. It has always sprung up” 36

“Let the city return to the swamp” Although a third of the population lived below the • Music – The beginnings of Jazz, Blues, Zydeco, Gospel, Cajun and Creole (Louis poverty line, a culture of free Armstrong “What a Wonderful World”,Fats and collective amusement has “Blueberry Hill”, Aaron Neville “Louisiana 1927”) emerged • Food – The amalgamation of all countries of the world The sounds and the flavors that are yet to be created 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 37

Final Lesson • The best and the worst of humanity • What really is Important 38

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Thank You 40