Impact of Hurricane Katrina on Healthcare Delivery for Pediatric Hematology Oncology Patients at Children's Hospital of New Orleans, 2005 - 2014
Authors: Raulji Chittalsinh M 
Published: October 2019

Abstract
Hurricane Katrina was one of the worst natural disasters to hit the United States. Pediatric hematology/oncology patients, having unique physical and mental health needs, are particularly vulnerable to social and mental effects of natural disasters. We conducted a study one year after Katrina to determine the impact of the hurricane on those under our care for sickle cell disease and cancer, conducting a two-step survey-based study at Children's Hospital of New Orleans. The first survey was conducted 1 year after Katrina, attempting to identify gaps in healthcare services for pediatric hematology oncology patients that could be remediated in the event of another disaster such as Katrina, e.g., what barriers to care they encountered; and their opinions as to how hurricane preparedness could be improved. Utilizing responses to this survey, we then implemented a "Hurricane Action Plan". Each year, at the beginning of hurricane season, families were given a questionnaire, which asked them about pertinent patient identification data; about their evacuation plan if a hurricane were to fall; about the presence of a hospital in the area to which they would evacuate; which pharmacy they would be using. They were assisted with updating their child's roadmap and were asked to have this updated copy of the roadmap (or other health information) with them in the event of an evacuation. Information given about the child/family's evacuation plan was then scanned to a flash drive by medical staff along with the child's health information. The families were also given information as to where the pediatric hematology oncology clinic would be held in case of evacuation and were instructed on how to contact the caregivers. A subsequent survey was performed 7-8 years later to evaluate the efficacy of those measures taken. In our first post-Katrina survey, more patients were found to be in lower socioeconomic and educational strata. In the first survey, a majority of our patients had evacuated before or immediately after the storm and some were even separated from their children. Only half of the families in our study had an evacuation plan in place for the hurricane and a third of the families did not know where they were going when they evacuated. This uncertainty made it quite difficult for the families to seek pediatric hematology/oncology care in the place of displacement. There was inadequate time for arrangements for referral to be made, for the child's medications to be procured, for an alternate provider to be identified, or even for the health records of the child to become available. A majority of our patient cohort was already at a higher risk of mental health disorders, and more than half the caregivers reported some kind of emotional disturbance in the child after the hurricane. With the second survey 7 years after the "Hurricane Action Plan" came into effect, we found that in subsequent hurricanes affecting New Orleans and the Gulf Coast, a significant number of families were still being displaced. However, a majority of families (78%) had a plan in place for evacuation and care of their child. This was a significantly better response than prior to Katrina. Families were now more likely to have a store of medications to last for at least 2 weeks. 92 % found the information given to them about alternative facilities and other possible care providers to be extremely helpful. We have found that the communication between families and those of us at CHNOLA who provide care for these children to be vital and hurricane preparedness to be a success.

Disclosures
No relevant conflicts of interest to declare.