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

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

Apr 12, 2023 241 likes •660 views

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

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90.04.32w 29.57.18n

Planning for Disaster Management Lessons learned Katrina, Rita, Ike and Gustav

Norman McSwain , MD

Professor of Surgery Tulane University Trauma director Spirit of Charity Trauma Center Medical Director PreHospital Trauma Life Support

Kyle F. Dickson, M.D. M.B.A.

Professor Baylor College of Medicine Southwest Orthopaedic Group, Houston, Texas kyledickson99@gmail.com cell 713-208-4168

Katrina 8 Years Later: Have We Learned Anything Yet?

Kyle Dickson MD, MBA Professor of Orthopaedics Baylor College of Medicine Southwest Orthopaedic Group

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Summary

  • Proper emergency management

planning (Get Involved-ask?)

–Food, water, generators, personnel, patient evacuations

  • Military

–Security –Communications

Kyle F. Dickson, M.D.

Professor and Director of Orthopaedic Trauma, Tulane University Chief of Orthopaedics, Charity Hospital Clinical Assistant Professor, LSU

Disaster (sudden onset of unexpected circumstances)

  • Natural (hurricane, earthquake, etc)
  • Mechanical (bus rollover, tanker

hitting casino, multi vehicle collisions, explosions, wind, etc.)

  • Biochemical (government most

concerned) “Explosions and bombings remain the most common deliberate cause of disasters involving large numbers of casualties'”

Sherma, Am J disaster Med 2008

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Beautiful Lakeview House for Sale

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New Orleans Hurricanes August 1779

Lessons learned from ground zero

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“New Orleans has dodged a bullet”

90.04.32w 29.57.18n

Wind

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Wind Hurricane

Mark Twain 1883

  • “There is nothing but that frail

breastwork of earth between the people and destruction”

9:50am Monday August 29, 2005

Surge >50 feet, Lake Ponchartrain elevated 15 feet 18th Street Canal

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8 Levee Breaks

Before After

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Industrial Canal Break

Flood

Water comes and stays

Charity Hospital Tulane

After

VA University Hospital

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

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13 On the Streets

A diabetic

Prisoners on the Interstate

Days without water or food while the world watched and FEMA trucks drove by

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14 Canal St. Six Flags -- Jazzland Power

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Power

Emergency (generator ) power (24 hours vs 80 hours, basement)

  • Red plugs
  • Ventilators, Operating Room, Selected

lights

  • EMR, Radiology, Lab, Pharmacy,

Communication

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Lesson 1

  • Proper Emergency planning

–Worst case scenario planning (Munich –F.E.M.A.) –Hundreds of school buses underwater (use of resources)

Lesson 1

–Common sense construction (generators in the basement or filled

  • n the first floor, fuel two blocks

away -80 hours) –Triage (who lives and who dies) Planning and Management

Problems

Inappropriate planning

not

mistakes in field-level decision making

Successes

Initiatives in front line medics compensated for lack of clear command by senior managers

Critical thinking by field personnel

Carresi Disaster 2008 Madrid bombing

Response

  • Immediate

– 2-5 days – Local resources only – Preparation – Storage – Communication – Command & control – Security – Evacuation

Sanitation Water Kitty liter Disposal bags Cleanser

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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

NEXT TIME, LET’S ALL BE BETTER PREPARED

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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)

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. Thank you, New Orleans, for making us number one.

Response

Reliable communication – Satellite phones (Ham radio system)

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Response

  • Immediate

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

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Hemingway called courage “grace under pressure”

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Lesson 3

  • Communications

–Between hospital and helicopters (other hospitals or the outside world) –Military –Orthopedic surgeons should be in charge (a lot less “dickin around”)

Response

  • Immediate

– 2-5 days – Local resources only – Preparation – Storage – Communication – Command & control – Security – Evacuation Towers down or damaged Batteries run out without recharging

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

Mark Twain

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A beached boat on Napoleon?

Fats Domino’s Living Room (The Fat Man – “Bluberry Hill”)

Before After

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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

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Debris

34 Normal Years of Garbage in 3 Months

Myths

  • f disaster management

I’m from the government I am here to help you

You are on your own for 72 hours There is no help

Hurricanes Gustav and Ike

  • A new challenge – two hurricanes – two

coasts - back to back

  • Orleans Parish hospitals evacuate pre-

storm

– LSU evacuated to other LSU hospitals – Tulane evacuates to other HCA hospitals – Ochsner Baptist evacuates to other Ochsner hospitals

Command and Control

  • Most important change from Katrina to

Gustav

  • Coordinated command and control
  • Leadership
  • Power and control
  • Private (HCA) and Public ( Charity) worked
  • Government system (FEMA) did not work

We must fend for ourselves The government is NOT here to help

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29 Disaster aftermath The US Third World

Human Resources

  • Medical
  • Administration
  • Infrastructure workers
  • Fatigue
  • Shift work

Non Human Resources

  • Power

– Electricity – Gas

  • Water

– Potable – Non Potable

  • Sanitation
  • Food
  • Medication
  • Equipment
  • Supplies
  • Communication
  • Transportation
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My Plea

  • Get involved! Orthopaedist are

needed (IGOT-OTI)

–Hospital emergency preparedness –Third World volunteerism

Time Money Sponsorship

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Summary

  • Proper emergency management

planning (Get Involved)

–Food, water, generators, personnel, patient evacuations, family

  • Military

–Security –Communications

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34 New Orleans 2 Years Later

  • Minimal Rebuilding in Lakeview
  • No guarantee levee can with stand level

5 hurricane

  • Insurance paid one third of the cost of

the house

  • ? Return of the “Soul” of New Orleans

Year 2 “I Wish I …”

  • Backed up thousands of patients in research

studies

  • Taken a greater role in Emergency

Management for the hospital (satellite communications, evacuation plans, power, water, security, and staffing)

  • Personal emergency preparedness

What I Wish I Knew

  • Planning (2-3 days to prepare not

plan)

  • Indentification/Badge for disaster
  • Water/Food
  • Family safe
  • Communication (satellite phones, ham

radios)

Guilty

  • Ran form New Orleans, ran from

Baton Rouge to Houston –Appreciation for my patients

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Guilty

“finddoctordickson.com” Nice to see friendly faces in hostile

lands –Art of medicine (not the business or science of medicine)

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

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37 “Let the city return to the swamp”

  • Music – The beginnings of Jazz, Blues,

Zydeco, Gospel, Cajun and Creole (Louis Armstrong “What a Wonderful World”,Fats “Blueberry Hill”, Aaron Neville “Louisiana 1927”)

  • Food – The amalgamation of all countries of

the world The sounds and the flavors that are yet to be created

Although a third of the population lived below the poverty line, a culture of free and collective amusement has emerged 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

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38 Final Lesson

  • The best and the worst of humanity
  • What really is Important
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40 Thank You