A hard rain's a-gonna fall
Shortly before Hurricane Isaac pummeled Louisiana in August 2012, DeSalvo was checking names off the state’s special needs registry, which identifies people who may need extra help during an emergency.
The then-New Orleans Health Commissioner met a wheelchair-bound veteran who managed several chronic conditions. His subsidized high-rise apartment complex lost power, which meant that he had been there for a couple days. He was hoarding food and water, like many of his neighbors.
“It wasn’t because a storm was coming; he had to live like that all the time. Our most vulnerable are always living on the precipice of disaster because they can’t get to where they need to for help,” DeSalvo said. “I found myself angry—we live in a system where a person has great health coverage, but the only person that went to help them was a health department director when the VA had the resources to help. We cannot and should not do this alone.”
That, in part, spurred New Orleans’ Empower Initiative, which features a geocoded map that uses Medicare data to inform first responders about who’s most vulnerable when disaster strikes.
“I was thinking I was doing all this good for public health, but the people who need you most don’t even know you exist. Maybe that’s one of the reasons I feel an obligation to amplify the messages and profile of public health because I want people to know someone in the community is there to help them,” said DeSalvo, noting that YouTube videos that amplified public health messaging during COVID-19 garnered more than 500 billion impressions.
Hurricane Ida tore through southern Louisiana on Aug. 30 with winds of up to 150 miles per hour, heavy rain and flash flooding. It knocked out an Entergy transmission system that cut off power to virtually all of New Orleans.
The storm set into motion emergency plans that hospitals have honed since Katrina and Isaac. While many hospitals weathered Ida relatively well, New Orleans residents who lost power and water may suffer long-term consequences.
"We are significantly more prepared than we were for Hurricane Katrina," said Greg Feirn, CEO of LCMC Health, which has six hospitals in the New Orleans area.
Katrina crippled health system infrastructure and overwhelmed operations.
Woman’s Hospital had to improvise a plan to onboard 122 critical newborns via its helipad. Staff called on local churches, shelters and other community partners to watch over relatively healthy infants and mothers when their hospital was full of acute patients, recalled Teri Fontenot, who was at the time CEO of the Baton Rouge hospital. Woman’s has since been written into readiness plans as the designated provider for vulnerable newborns.
“We learned that we need to develop and sustain our relationships with our partners at churches and shelters,” Fontenot said. “The Office of Emergency Management also realized it needed to coordinate its response with private entities, not just public.”
The federal government has invested $6.8 billion in healthcare disaster preparedness since 9/11, according to HHS' Office for the Assistant Secretary for Preparedness and Response. Some was earmarked for biohazard preparation. But the disaster plans weren’t well distributed or widely practiced and Louisiana was caught somewhat flat-footed when Katrina hit, DeSalvo said.
“Going into Katrina four years later, there hadn’t been the funding or attention on a similar scale for hurricane preparedness,” she said. “That underscored the importance of an all-hazards approach in preparedness, which we do pretty poorly in America.”
Ready or not
Hospitals should invest in internal and external communication infrastructure, surge capacity, regional coalitions, care continuity plans, staffing contingency scenarios and supply chain management that would apply in all types of disasters, stakeholders suggest.
Congress passed the Pandemic and All-Hazards Preparedness Reauthorization Act in 2013, which in part authorizes funding for public health and medical preparedness. But progress in all-hazards planning varies by region.
Health systems across Colorado, Maryland and New Mexico, among other states, have a regional healthcare information exchange that pools electronic health record data. Providers can track bed availability, personal protective equipment supply levels and staffing trends.
“We were able to move together as a system so that one hospital didn’t stand alone,” Marcozzi said.
But in some regions, Mays noted, coalitions are “entirely disconnected from regional healthcare information exchanges. We have a long way to go to build out coordination at a local level.”
Hospitals have been focused on trimming expenses. The pandemic exposed the limitations of that approach, Mays said, adding, “The short-term spending we incur as a nation to quickly develop surge capacity is far more costly than making sound incremental investments over time.”
The intake process, for instance, narrows from seven steps to one or two during a disaster. Typically, systems gather contact information, medical history, verify coverage, collect copays, set up payment plans and consent forms before treatment begins. That process should be streamlined, Marcozzi said.
During Katrina, Woman's Hospital temporarily waived patient data privacy laws; the state and federal government eventually followed suit, Fontenot said. Executives also reduced the steps to grant emergency practice privileges.
“Parents were as far away as Oklahoma—it still gives me goosebumps to talk about it. We decided the hell with HIPAA,” Fontenot said, noting that it’s now common practice to relax data privacy and licensure laws during an emergency. “Policies and procedures are important during normal times, but sometimes you have to do what you can to make sure patients are taken care of as safely as possible."
Colorado and Maryland were among the 20 states and the District of Columbia that were ranked in the highest preparedness tier, as calculated by the Trust for America’s Help, which borrowed some data from the National Health Security Preparedness Index. A large grouping of states in the South, including Mississippi, Oklahoma and West Virginia, were among the least prepared and most vulnerable. Those states also have some of the lowest levels of public health emergency preparedness funding in the country.