1. Emergency Public Health Response to Hurricane Katrina and Hurricane Rita in Louisiana Fall 2005 Ted Misselbeck Public Health Advisor Nashville TN May 2006

2. Hurricane Katrina: 8/29/05 The Day the Music Died

3. Hurricane Katrina The largest natural disaster in United States history The magnitude of this disaster is not easy to appreciate

4. Hurricane Katrina New Orleans Texas Florida This was a monster storm 450 miles wide

5. Hurricane Katrina New Orleans Texas Florida Bay St. Louis MS The recorded storm surge of 30 feet high in Bay St. Louis, MS was the highest ever recorded in U.S. history

7. Rayne Temporary State TB Control Office

8. Emergency Public Health Concerns New Orleans Health Department flooded and closed Heres the deal... 1. Heres how we are managing things right now...

9. Emergency Public Health Concerns New Orleans TB staff: TB Manager # 1 in Shreveport, La. TB Manager # 2 in Houston, Texas Nurse Practitioner in Monroe, La. State secretary house submerged to the roof- living with relatives

10. Emergency Public Health Concerns State Lab closed No alternative in-state lab available to process sputum specimens 2.

11. Emergency Public Health Concerns State Lab closed Dr. Charles Wallace TB Control Officer and Texas to the rescue! 2. Texas Provided self-pay mailers (he sent cases ) for specimen processing

12. Emergency Public Health Concerns This was the supply for all the TB patients throughout the State of Louisiana State of Louisiana pharmacy and supply room flooded and closed 3.

13. Emergency Public Health Concerns Joe Ware and Versapharm to the rescue- R. Joe Ware President tell us what you need and we will send it- dont worry about the bills now

14. Emergency Public Health Concerns pharmacy 3. Procedure: Order meds from Versa Pharm 1.Versa Pharm sends all meds for State to Lafayette, LA. Health Dept. 2. Meds separated by 9 La. Regions

15. Emergency Public Health Concerns pharmacy 3. 3. All meds delivered by car 4. Sputum cans also given to be delivered to each Region at the same time.

16. Emergency Public Health Concerns All 132 TB patients from New Orleans area are missing... 4. and we need to find them!!!

17. TB Control Officers new State office Our new Lafayette La. office became: (the check is in the mail!) New State TB Billing Office invoice (buying and payer) Statewide TB supplies

18. National Hotline Center (receiving phone calls about found TB patients from health departments around the United States) Our Lafayette La. office became:

19. The new State Pharmacy distribution Center for all of Louisiana Our Lafayette La. office became: Our new Center comprised of two rooms 15 x 20 feet! The new State Sputum Can Distribution Center

20. Finding New Orleans area TB patients The detective process Lafayette Office phone number distributed nationally for reporting found New Orleans patients Provide CDC with daily update list Updated daily list sent to TB controllers to continue national search

21. Finding New Orleans area TB patients The detective process After about a month we were able to get lists of registered shelter clients from FEMA (in Texas) This helped in identifying new locations of about 15 TB patients in Louisiana and Texas

22. Finding New Orleans area TB patients The detective process Walgreens list (new local address and old New Orleans address) We found about 3 TB patients through these lists

23. Finding New Orleans area TB patients The detective process Every possible.com lists Katrina.COM Hurricane Katrina.COM Missing Katrina relatives.COM We found 4 TB patients through this effort

24. Finding New Orleans area TB patients The detective process The main daily process: of phone calls to patients homes, cell phones, emergency contacts and following up leads in other states We found 100 or more TB patients through this method Hundreds

25. Finding New Orleans area TB patients Where? did all the TB patients go??? The big question:

26. Weekly March 31, 2006 / 55(12);332-335

27. Emergency Public Health Concerns The Changing geography... Baton Rouge, Louisiana becomes the largest city in Louisiana overnight From 400,000 to over 500,000

28. Out of New Orleans' pre-Katrina population of city officials now estimate have returned. 462,269 189,000

29. The New Orleans TB detective team Try and get to homes to determine if TB patients are still living there- -or as time went on- did they return? Make inquiries in neighborhoods if anyone knows their whereabouts

30. Weekly March 31, 2006 / 55(12);332-335

31. Here come Hurricane Rita!!! You gotta be kidding me!!! Just when you think you are out of the woods...

32. ? Houston Dallas Little Rock Hurricane Ritas track

33. This time the Western part of Louisiana was hit Lake Charles Louisiana

34. Retur n Route

35. Lake Charles

36. TB Control plan for Lake Charles and Western Louisiana Parishes post-Hurricane Rita Set-up contingent reporting network format similar to Hurricane Katrina (if needed)

37. Lessons learned from Hurricane Katrina Instructions to TB patients days before hurricane hit 30 days worth of meds given to all patients Result: All TB patients tracked and accounted for okay October 2005 March 2006

38. Comparison : Hurricane Katrina vs. Hurricane Rita Time Wind speed Size (width) Radius of winds Movement Coastal Surge U.S. Deaths

39. 6 months later some numbers FEMA has filled only 48,158 of the 90,000 trailer requests 215,000 homes destroyed 189,000 of 500,000 pre-Katrina residents have returned Only 20 of 128 public schools are open

40. Med-1 unit (12 beds minor surgery) has set up in parking lot between Charity and LSU Medical Center Charity Hospital may never open again 5,200 hospital beds pre-Katrina 1,200 beds now (mostly full) Hospitals

41. New Orleans school open as of 1/25/06

42. New Orleans Health Services open as of 1/25/06

43. Are we prepared for an earthquake?... Where ?

44. New Madrid, MO fault line (1811-1812) Mississippi River ran backwards forming new lakes

45. Can this happen again?? Tennessee responding to Hurricane Katrina in making disaster plans to this and other disaster scenarios

46. and those who are in the shadows of life, the sick, the needy and the handicapped. It was once said: Hubert H. Humphrey Former Vice President of U.S. The moral test of Government is how that Government treats those who are in the dawn of life, the children, those who are in the twilight of life, the elderly,

47. How did we measure up as a nation to this disaster? How do you think we will measure up the next time? For us to ponder...

48. Questions??