Preparing for a disaster takes a team approach

September 2007

TORONTO — The aftermath of the 2005 hurricanes Katrina and Rita brought particular difficulties for children and adults with both rare and chronic diseases.

“The important thing to remember is that all disasters start and end locally so whoever is at the disaster site within the first 24 to 72 hours are the ones who will be dealing with it,” David B. Canton, of the National Disaster Medical System of the Department of Homeland Security, said at the Pediatric Academic Societies’ Annual Meeting, recently held here.

“The better-prepared the local people are, the better off they will be in the end. The two groups that are most affected by a disaster may be children and people with special needs. These are the people who don’t have the ability to leave the area and go somewhere else. So you already have everyone stressed and on the edge, and then once the disaster strikes, they are even further over the edge and at risk for problems,” he said.

A study by Jess Theone, MD, and colleagues from the Hayward Center for Human Genetics at Tulane University and the Tulane Center for Clinical Effectiveness and Prevention, both in New Orleans, summarized the difficulties that were faced in attempts to restore medical care to patients in Louisiana after hurricanes Katrina and Rita.

“There were hundreds of thousands of people who lost everything. I cannot emphasize how strongly I fault every level of the government — except for our uniformed services, who were outstanding — for what happened and for not doing anything to prevent what they knew would happen. There was a mock hurricane drill one year prior, and everything that happened then happened in 2005 and nothing was done to prepare for this. It is just horrible,” Thoene, who is now director of the Biochemical Genetics Laboratory and active professor emeritus of pediatrics of the University of Michigan, told Infectious Disease News. Thoene and Ken Pass are co-chairing a committee of the American College of Medical Genetics, which is attempting to develop a white paper to outline improved approaches for metabolic disease patients during mass disasters.

The authors of the published study in Molecular Genetics and Metabolism concluded that planning and preintervention are required and that the current system is geared more toward common injuries and disabilities than people with more “special needs diseases.”

According to the researchers, proper planning may result in significantly improved recovery after a national disaster with actual cost-avoidance because ICU admissions may be averted.

“Our nutritionist [at the Tulane Center] had a back-up database and had medical records with her. We also knew our patients’ medical history, so we were able to cope better than what people may have thought. A system such as a central off-sight back-up medical record would have been better, but none of our recommendations have been implemented as of yet,” Thoene said.

CDC’s emergency system

“We believe that a special duty for the CDC is to help clinicians react quickly when there is a harmful event that they do not typically see,” Marsha L. Vanderford, PhD, director of the CDC’s Emergency Communications System, said at the meeting.

The emergency communication system is an all hazards, coherent communications framework for the coordination of delivering critical health information to diverse audiences.

Since many services that are online are not helpful in an emergency disaster, the CDC has several mechanisms to communicate with physicians on topics of urgent concern and interest.

These mechanisms include conference calls, a clinician registry, a satellite webcast and broadcast, and a 24/7 telephone response team.

For more information on the emergency communication system, visit www.bt.cdc.gov/coca.

“Toward the end of the hurricane response, we worked with a number of groups to identify how well the CDC did and how we can do better. The results indicated the information on the CDC’s website was good and what had been pushed out was good, but we needed to find some way to get critical information to clinicians in a rapid way. We are now working on this, and we welcome any suggestions clinicians may have,” Vanderford said.

“We need to be more flexible. We have since changed from specialty teams to having more of a one-unit approach. We need to be able to put several teams together to function in a disaster and need to improve our logistics capability,” Canton said. “Each region has their emergency coordinator, so those in charge of disaster preparedness should find out who their coordinators are.”

“As a nation, we have to demand some sort of a permanent electronic record. We cannot look to the federal government to help us. We will have to launch an initiative that will allow people who are involved in a mass casualty to fend for themselves. They should take their records with them so that they can then find an appropriate doctor,” Thoene said.

For more information:

• Pass K, Thoene J, Canton D, Vanderford M. Disaster preparedness: A paradigm for survival of health care systems. #5525. Presented at: the Pediatric Academic Societies’ Annual Meeting; May 5-8, 2007; Toronto.
• Andersson HC, et al. Genetic/metabolic health care delivery during and after hurricanes Katrina and Rita. Mol Genet Metab. 2005;doi:10.1016/j.ymgme.2005.10.002. Accessed July 12, 2007.