MEDIA REVIEWS

NATURAL DISASTERS AND PUBLIC HEALTH: HURRICANES

KATRINA, RITA, AND WILMA

By Virginia M. Brennan, Editor.Baltimore: The Johns Hopkins University Press, 2009;311 pp; $30.00 (softcover).

Hurricane Katrina, in August 2005, was the costliestnatural disaster in U.S. history. For most of the coun-try, the storm was like a horrid dream that has sincebeen forgotten, but for residents of the U.S. Gulf Coast,traumatic memories, uprooted neighborhoods, eco-nomic struggles, lingering questions about levee safety,and an increase in the number of people with pooraccess to health care ensure that the nightmare willcontinue.

Two days before the hurricane made landfall, the fed-eral government declared a state of emergency for theU.S. Gulf Coast, yet mandatory evacuation orders wereissued less than 24 hours before the storm struck. Manyresidents underestimated the storm’s potential, andeven more had no definite plans or means for escapingthe storm. What lessons can we learn from HurricaneKatrina, and how can we make certain that the U.S.Golf Coast is more prepared for the next ‘‘storm of thecentury’’?

Natural Disasters and Public Health: Hurricanes Kat-rina, Rita and Wilma, a poignant book written by morethan 30 authors and edited by Virginia M. Brennan,PhD, MA, is a sobering and thought-provoking look atone of the worst natural disasters in the United States.It highlights how impoverished groups suffer whentheir communities have no ‘‘voice in the decisions thataffect their health, environment, and quality of life,’’and it offers some practical solutions to help us preparefor natural disasters.

The book is divided into 26 chapters, with most chap-ters presented in the form of a research study or sum-mation paper involving the many different outcomesfrom various agencies affected by the storms. Collec-tively, the papers address lessons learned when a coun-try is short-sighted and ill-prepared to meet thedemands of a natural disaster like Hurricane Katrinaand ‘‘the need for comprehensive, but dynamic andflexible disaster-preparedness plan that involves all keycomponents of society.’’

Many chapters in the book, especially Chapter 9,‘‘Hurricane Emergency Planning by Home Health Pro-viders Serving the Poor,’’ by Dahlia Kirkpatrick, MD,and Marguerite Bryan, PhD, offer some insightful solu-tions on improving the ‘‘emergency response toimpending disasters for underserved and indigent pop-ulations.’’ The solutions offered are not only applicableto impoverished communities and home health provid-

ers, but to any state, region, or country that is seriousabout preparing for natural disasters.

Having a timetable for mandatory evacuation and anevacuation plan that is comprehensive, flexible,rehearsed, and not dependant on local governmentalresources is the criterion standard in preparing for anatural disaster. In addition, the plan must involvecooperation and coordination between local businesses,agencies of like-minded interests, and services in unaf-fected regions of the state or country. Essentially, allemergency departments should have clear andrehearsed disaster plans, as they likely will be affectedto some degree by any type of crisis impacting theirrespective communities.

An example of a successful spontaneous evacuationinvolved the Chief Executive Officer (CEO) of St.Charles Parish Hospital in Luling, Louisiana. He wasable to transfer all patients and close the hospitalbefore the storm arrived, because ‘‘Desoto Hospital inMansfield Louisiana, some 300 miles away, agreed toaccept the patients.’’ While the CEO should be com-mended for a job well done, this illustrates how therecould have already been a letter of agreement betweenboth hospitals, outlining steps to follow in case eitherhospital faced a major disaster.

The consensus of the book is that most successfulevacuations are implemented 72 hours or more beforethe potential disaster arrives. This ensures enough timeto contact family, clients, support personnel, andaccepting facilities and ample time to organize the evac-uation, to avoid highway congestion, and to establishoperational continuity at the destination. There arecountless accounts of how limited time led to addedstress and chaos and contributed to overcrowding thehighways, people forgetting livesaving medicines, andhaving to make spur-of-the-moment life-and-deathdecisions during the hurricanes.

Even if the evacuation plan is implemented in atimely fashion, unforeseen problems will sabotage thebest-laid plans during a natural disaster, according toDr. Kirkpatrick and Dr. Bryan. During Hurricane Kat-rina, high winds toppled numerous power lines, tele-phone lines, and cell phone towers, and the resultantloss of communication led to added chaos. The U.S.military, the Federal Emergency Management Agency(FEMA), and first responders all have communicationstructures that rely on auxiliary power supply andbackup radios. Hurricane Katrina could have been lessof a disaster if local and state government, the military,FEMA, and first responders had all been given accessto the same communication systems.

Finally, a sobering and thought-provoking look atHurricane Katrina is presented in Chapter 2, ‘‘KatrinaPerspectives on the Environment and Public Health,’’

ISSN 1069–6563 ª 2010 by the Society for Academic Emergency Medicinee52 PII ISSN 1069–6563583 doi:10.1111/j.1553-2712.2010.00760.x

written by Bailus Walker Jr., PhD, MPH and RuebenWarren, DDS, MPH, DrPH. They assert that low-income communities, like New Orleans’ Ninth Ward,are often at a major disadvantage, because of theirproximity to various threats such as ‘‘hazardous land-fills, incinerators, abandoned toxic waste dumps, andheavy vehicular traffic routes.’’ As a consequence, thesecommunities are more likely to suffer from environ-mental-related health issues and public health disasters,and they need a ‘‘voice in the decisions that affect theirhealth, environment, and quality of life.’’ Drs. Walkerand Warren also assert that our public health infra-structure needs an infusion of innovative ideas andincreased financial support if it is to address environ-mental problems, build ties to the mental health field,and meet the health care needs of the medicallyindigent, especially in this time when we are all suscep-

tible to the next infectious pandemic, natural disaster,or terrorist attack.

In summary, Hurricanes Katrina, Rita, and Wilmacombined were the storms of this century, and thisbook does an excellent job of outlining their effects onmany components of health care. It also illustrates valu-able lessons learned and provides practical solutions tohelp us prepare for the next major storm. This bookshould be required reading for everyone who is cur-rently content with our nation’s natural disaster pre-paredness plans and public health infrastructure.

Kathleen Cowling, DO(Cowling911@yahoo.com)Dalkeith Tucker, DOSynergy Medical Education AllianceSaginaw, MI

ACAD EMERG MED • June 2010, Vol. 17, No. 6 • www.aemj.org e53