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Katrina veteran says IOM study a report, not a plan

For most, making plans for how to provide healthcare after a disaster strikes is something of an esoteric exercise. But Dr. Lee Hamm of New Orleans has been there and done it, and he offers a mixed review of the latest Institute of Medicine report on the subject."Crisis Standards of Care, A Systems Framework for Catastrophic Disaster Response" outlines a process to establish and implement crisis standards to apply in resource-scarce disaster conditions.

Hamm, executive vice dean at Tulane University School of Medicine, was at the Tulane University Hospital and Clinic (now known as Tulane Medical Center) when Hurricane Katrina hit New Orleans on Monday, Aug. 23, 2005, and he spent the next five days there. Hamm described the IOM report as a "potentially valuable document," but he wondered whether it was specific enough to be implemented and to be effective if ever put it into use.

"It's a report, not a plan," Hamm said, explaining that the report could be useful from a conceptual standpoint but that it falls short of being a how-to guide. He compared it to suggestions that the answer to the federal deficit is to increase revenue and cut spending.

"Yes, but how do you get there?" Hamm said. "Still, it's better to have the report and know people are thinking about it."

Hamm said the report's emphasis on regional coordination was good, but he added that the report's call for hospitals to be "as prepared as possible" to operate autonomously for the Joint Commission emergency standard of 96 hours was of vital importance.

"There's a recognition that you may be on your own," Hamm said. "We had plans, but what we really didn't have plans for was the prolonged isolation with our emergency generators not being there for us. The things that are the most problematic are the things you didn’t think about.”

In the grand scheme, Hamm said, these things were fairly trivial but caused problems at the time. For example, with the elevators not working, Hamm recalled how patients had to be carried down stairs. There are stretchers designed for this purpose, but the hospital did not have them.

Hamm said quick coordination facilitated by having cooperative agreements in place helped mitigate some problems caused by last year's tornado in Joplin, Mo., but he added that most places don't appear to be prepared for disasters.

Hamm said that, as the international response to the Jan. 12, 2010 earthquake in Haiti illustrated, modern technology is no substitute for planning and preparation.

"There were lots of people trying," Hamm said of the earthquake response. "But it was not as coordinated and useful as one might expect in modern day."

Follow Andis Robeznieks on Twitter: @MHARobeznieks.
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