Can it get any worse

THE TWO FEATURE articles presented in this issue of Frontiers of Health Services Management speak to the challenges of Hurricane Katrina. The Tulane experience lists a multitude of problems, solutions, and successes, whereas the article by Drs. Rodriguez and Aguirre speaks to the impact on the infrastructure following the hurricane. In the federal report, "The Federal Response to Hurricane Katrina," the White House (2006) has labeled Katrina as "the most destructive natural disaster in U.S. history." Dr. E. L. Quarantelli (2006) might call Katrina a catastrophe. Regardless of what one calls the event, Hurricane Katrina has shown that the challenges leading up to and following a disaster/catastrophe will overwhelm everyone. People must understand that they cannot wait for a government, any government, to help them. We must be prepared to help ourselves. PREPAREDNESS The discussions of preparedness in both articles recount many of the overwhelming factors that affected the situation in New Orleans. The city is below sea level, it sits between Lake Pontchartrain and the Mississippi River, and it is in very close proximity to the Gulf of Mexico. One would think that hospitals would keep this in mind during construction and place emergency generators at higher levels than the ground floor. Storm surge is common during and after hurricanes. According to the Saffir-Simpson Hurricane Scale,1 a category V hurricane will have sustained winds of "greater than 155 miles per hour," and storm surge could be "greater than 18 feet." Hospitals need to look at the possibilities of events in the area in which they are located. Hospitals along the coast must consider hurricanes, tsunamis, and storm surge because they are possible. Inland hospitals do not have the same concerns; however, from a possible disaster standpoint, inland hospitals do have threats that could be just as devastating as Hurricane Katrina. In the northern part of the United States, ice is a threat. Ice storms could cripple a hospital just as easily by causing a loss of power and infrastructure. Hurricanes can also affect inland hospitals. Hurricanes that travel inland can dump significant amounts of rain on areas, creating flash flooding. In most cases, hospitals prepare for service disruption, not evacuation and total loss of services (U.S. GAO 2006). Most have practiced vertical and horizontal evacuation but not total evacuation. Hospitals in hurricane-prone areas have performed phenomenally in getting back to business after devastation. After Katrina, getting back to business was nearly impossible, if not impossible; the flooding took that option away. Callimachi (2006) showed that 50 percent of the hospitals in New Orleans dosed and over half of the doctors were displaced. RESPONSE Local, state, and federal responses to Hurricane Katrina created unmanageable problems for the citizens of Louisiana, Mississippi, and Alabama. Those who decided to leave had trouble getting to points north and west because of traffic jams. Those who stayed experienced a mounting list of problems that culminated in thousands needing rescue. The number of fatalities differs depending on the source, but most agree that at least 1,800 died and at least 1,800 more are missing. Response to a catastrophe of any kind is difficult. The people working through Hurricane Katrina reacted in a typical variety of ways to the disaster. According to the account of Bovender and Carey, personnel at Tulane Hospital did a phenomenal job overcoming the multitude of problems. Rodriguez and Aguirre pointed out that the problems caused by the disaster created havoc resulting in hospital closures and loss of personnel. Frankly, not all responses to catastrophic events will have a positive outcome. Disasters or catastrophes create overwhelming human need that may be difficult if not impossible to meet. BEHAVIORAL HEALTH Neither article speaks to the behavioral health needs of the people involved in the hurricane and resulting flooding. …