Hurricane Katrina struck the Gulf Coast in late August 2005, causing extensive wind damageand catastrophic flooding, and leading to Presidential disaster declarations for Alabama, Florida,Louisiana and Mississippi. The storm was one of the worst natural disasters in the nation's history. Hurricane Rita, which made landfall along the Gulf Coast in late September 2005, was somewhatless severe than Katrina when it hit. But a few days earlier in the Gulf it had been a powerfulcategory five hurricane. Government officials and citizens shaken by the devastation of the earlierstorm mounted aggressive preparedness efforts in anticipation of Hurricane Rita, drawing on lessonslearned from Katrina just weeks earlier. Hurricane Katrina is estimated to have killed more than 1,200 people, and displaced about2 million. The death toll continues to be revised, as bodies continue to be found, and investigationsinto the causes of death of others continue. (1) More than 4,000 persons are still reported missing. The FederalEmergency Management Agency (FEMA) recently increased its estimate of the number of personsdisplaced by Hurricanes Katrina and Rita to about 2 million. (2) The logistical hurdles posed by Hurricane Katrina were formidable. Communications wereknocked out in hard-hit areas, which compromised the process of assessing and prioritizing needs. Physical access was blocked in some areas, and civil disorder was a problem in some others. Eachkept responders from delivering aid. In some cases, victims were isolated without water andmedicines, and hospitals that had not been evacuated before the hurricane were unable to sustainoperations. Each circumstance required the emergency evacuation of critically ill patients to a triagecenter, which then itself became overwhelmed. Federal, state, and local governments, businessesand corporations, the faith community and other volunteers all pitched in to speed relief to Katrina'svictims, but keeping all of it coordinated was a challenge. Responding to a catastrophe of the scope of Hurricane Katrina requires that a variety ofpublic health and medical activities be carried out and coordinated. Public health activities are thosethat identify, address or prevent health problems in populations. Examples include assuring thesafety of food and water, preventing the spread of disease in shelters, evaluating the safety ofneighborhoods for rehabitation, and assuring the health and safety of responders. Medical activitiesare those that deliver healthcare services to individuals. Examples include treatment of injuries,continuity of care for those with chronic illnesses, mental health counseling, and cause-of-deathinvestigation. The medical response to Hurricane Katrina may have posed the greater challenge. The publichealth response required the coordination of variety of agencies, community-based organizations,and private parties at different levels of government, though these entities had generally workedtogether in the past. The medical response, in contrast, required the coordination of a broader mixof federal, state and local government agencies, private parties and others, with no comparable recentprecedent or experience in such an effort on this scale. Over the past decade, in response to the Oklahoma City bombing, the terror attacks of 2001and several serious natural disasters, Congress and the Administration created new authorities,structures and plans to assure that government at all levels can respond well to disasters likeHurricane Katrina. Local and state governments are to be the first responders in a disaster. Whentheir resources are overwhelmed, federal assistance is provided under the Robert T. Stafford DisasterRelief and Emergency Assistance Act (the Stafford Act) and other authorities. A new NationalResponse Plan (NRP) places the Secretary of Homeland Security in charge of coordinating theoverall federal response. The Secretary of Health and Human Services (HHS) is in charge ofcoordinating the federal public health and medical response during a disaster. In the wake of Hurricanes Katrina and Rita, Congress is likely to review response efforts,recent public health preparedness laws and the NRP. While even the best plan and response maybe overwhelmed in a disaster of the scope of Hurricane Katrina, Congress may nonetheless findopportunities to revisit management structures, programs and goals in order that national responsecapability can be steadily improved. This report will discuss relevant authorities and response plans that guided the public healthand medical response to the 2005 hurricanes. Given its catastrophic scope, the response to HurricaneKatrina will be the primary focus of this report, with reference to the Hurricane Rita response whenrelevant. The roles and response activities of selected agencies in HHS and DHS will be discussed.Finally, a number of policy issues will be discussed. This report will be updated as circumstanceswarrant. For a broader discussion of all-hazards public health and medical preparedness, see CRS Report RL31719 , An Overview of the U.S. Public Health System in the Context of EmergencyPreparedness . The Stafford Act authorizes the President to issue major disaster and emergency declarations,whereupon federal agencies are authorized to provide assistance to affected states. (3) Through executive orders, thePresident has delegated to the Federal Emergency Management Agency (FEMA), within DHS,responsibility for administering the major provisions of the Stafford Act. In calendar year 2005,President Bush issued 48 major disaster declarations, including those for Alabama, Florida,Louisiana, and Mississippi for Hurricane Katrina, and for Texas and Louisiana for HurricaneRita. (4) Activities undertaken under authority of the Stafford Act are provided through fundsappropriated to the Disaster Relief Fund (DRF). Federal assistance supported by DRF money is usedby states, localities, and certain non-profit organizations to provide mass feeding and shelter, restoredamaged or destroyed facilities, clear debris, and aid individuals and families with uninsured needs,among other activities. Federal agencies that receive mission assignments from DHS and provideassistance pursuant to the NRP are also reimbursed through funds appropriated to the DRF. Inaddition to the FEMA assistance authorized by the Stafford Act, a wide range of aid is provided byother federal agencies under their general statutory authority. The National Response Plan (NRP) is the framework under which federal and voluntaryagencies are instructed to operate when a disaster occurs. (5) The NRP was released by DHS in December 2004, replacing theprevious Federal Response Plan. The NRP is an administrative plan and does not establish newfederal authorities. In general, federal responsibilities in the plan are intended to assist state andlocal authorities, not to replace them. According to the NRP, which is under the overall coordination of the Secretary of HomelandSecurity, the Secretary of HHS is tasked with Emergency Support Function (ESF) #8, thecoordination of public health and medical services, as laid out in the plan's ESF#8 annex. (6) HHS is responsible forcoordinating the following activities under ESF#8, and may request assistance from 14 designatedsupport agencies and the American Red Cross as needed: Assessment of public health and medical needs; Health surveillance; Medical care personnel; Health and medical equipment and supplies; Patient evacuation; Patient care; Safety and security of human drugs, biologics, and medical devices, veterinarydrugs, and other HHS-regulated products; Blood and blood products; Food safety and security; Agriculture safety and security (principally with regard to food-producinganimals and animal feeds and drugs); Worker health and safety; All-hazard public health and medical consultation, technical assistance andsupport; Behavioral health care; Public health and medical information; Vector control (e.g., control of disease-carrying insects androdents); Potable water, wastewater and solid waste disposal; Victim identification and mortuary services; and Protection of animal health (principally with regard to HHS-regulated animalfeeds and drugs). The HHS Concept of Operations Plan (CONOPS) for Public Health and MedicalEmergencies outlines how HHS plans to implements its emergency preparedness and responseauthorities and establishes the department's policies for emergency preparedness and response. (7) The CONOPS plan designatesthe Secretary of HHS as the official responsible for the overall response to public healthemergencies. The Assistant Secretary for Public Health Emergency Preparedness (ASPHEP) is toact on behalf of the Secretary to direct and coordinate the department's efforts, including on-sceneoperations and liaison with the DHS and other federal agencies. The plan lays out additionalresponsibilities of HHS offices and agencies during an emergency. (8) HHS does not bear primary responsibility for mass care, which is the coordination ofnon-medical services such as shelter, feeding, emergency first aid, and efforts to reunite displacedfamily members. Mass care is the responsibility of DHS and is carried out by FEMA and theAmerican Red Cross according to ESF#6. HHS is also not responsible for urban search and rescue, which is also the responsibility of DHS and FEMA pursuant to ESF#9. Furthermore, HHS maydepend on numerous other agencies to carry out certain of their ESF activities (e.g., public safety,road clearing and power restoration) before some ESF#8 activities can commence. Many of HHS's responsibilities under ESF#8 are within the department's primary control. An important exception is the National Disaster Medical System (NDMS), which comprises teamsof medical professionals who are pretrained to deploy and provide medical services in the immediateaftermath of a disaster before other federal assets arrive. NDMS, which previously operated underthe Public Health Service in HHS, was transferred to DHS in the Homeland Security Act of 2002( P.L. 107-296 ), and now operates under FEMA. NDMS will be discussed in greater depth insubsequent sections of this report. Certain other critical components of the medical response arehoused in the Departments of Defense and Veterans Affairs, and the private sector.