There was a lack of preparedness all the way around. One of the first resounding blames has to go to Homeland Security. I remembered even under the direction of Tom Ridge there was a lot of emphasis placed on 'First Responders.' First Responders took high profile after September 11, 2001 and the 'idea' of being prepared beyond what the USA already was became a bit of an obsession. I am not saying having First Responders trained in their field isn't necessary, it is. But, what the focus surmounted to was 'drills' with little to know emphasis on what actually happens in a time of emergency.
The 'drills' were high profile, example below:
NHSRC's Red Team Participates in Postal Service Emergency Exercise (click on)
They were laced with a lot of 'Hollywood' excitement, the news reports were all favorable with references to any and all shortcomings and I believe that is all fine and good. Without such preparedness in pratice I doubt sincerely there would be anyone in this country who gave much thought to what a dirty bomb might do to a populous of people or a weapon of mass destruction. There might be a chance First Responders could save lives and certainly to that end we all needed to know.
What was left out of the equation was the 'aftermath' that would be faced when the First Responders were successful and there was isolation of an entire populous of people. In my contemplation of the very good system New Hanover Health Network had for Wilmington during a time of emergency, namely a hurricane, I wandered through the possibility of Katrina and beyond Katrina.
Wilmington had it's Katrina. The name of the storm was Floyd. For an entire week Wilmington, North Carolina had returned to an earlier state and became an island mostly cut off from the mainland. It relied completely on itself and for those that did not evacuate from Wilmington they did fairly well, but, after a week it was time supply trucks found their way to the city and people were pleased at new supplies and a return of friendly and familiar faces.
When I think of Katrina and it's abandonment by authorities, I do blame Homeland Security first.
Granted, New Orleans and especially the Ninth Ward is not Wilmington. Wilmington sits 'naturally' above sea level but the 'bowl' that is New Orleans exists in the surrounding landscape that was once 'naturally' ocean bay. Wilmington at one time was only reachable by boat. As time passed, lagoons were drained and filled with the same process noted in Florida of their swamp land. People built homes and it was those homes that took the hardest hit and where several deaths took place during Floyd. So in essence, Homeland Security already had a model of survival for New Orleans and their anticipation of "The Big One." It was pre and post Floyd, only no one paid attention.
In preparing for hurricanes and large storms as just experienced by Wilmington an interesting set of standards are used.
l. The hospital and it's occupants will be secluded during a severe storm, therefore it has to be it's own city so to speak. And the highest point in Wilmington is the hospital, by the way. Twenty whopping feet above sea level. Just imagine what sea level rise will do for Wilmington. Bye, bye. We really don't want that to happen here, okay? So the folks in Wilmington, North Carolina and the entire Carolina coast pay attention and are well invested in reversing the trends of Global Warming. But, that is getting off subject.
2. How do you turn a busy hospital into a self contained facility to care for the ill? Well, a 24 hour staff is necessary. So the staff is divided into three teams.
Team A - the Pre-Storm emergency personnel. They might be on duty for a day or two depending on the rate of travel of the storm. They provide respit for the oncoming staff that will sustain autonomously through the storm.
Team B - the During the Storm emergency personnel. They are people well seasoned and capable of taking care of people when no other resources are available. They know they are the only people available for the patients and those that might be brought during the storm, so they take care to sleep on schedule and wake to a day of inhouse news and function to carry on until the city is deemed relieved of danger of any storm processes. That might be a length of stay of one to four days as the returning staff has to make it safely to the hospital to take on their duties.
Team C - the After the Storm emergency personnel. They arrive to relieve a very tired Team B. They resume normal operations after the storm to a community returning to disaster and possibly death yet to be discovered.
3. Now that the personnel are in place and prepared, how do you turn a hospital into a small city?
You break it down. Supplies. Food. Water. Security. Electricity. Authority.Supplies are on the grounds of the main building. I understand we have about 90 days of most frequently used supplies and a month of all else.
Food. There are two kitchens. One is where staff has lunch and it prepares patient meals. It is well supplied for the duration and stays open throughout the entire time there is an emergency. There is also a second 'visitor' kitchen affiliated with the coffee shop. They stay open as well and serve their usual speciality coffees and home bakings that the staff has grown an affection for.
Water. There is always city water, but, there is also filtered water processes for the hospital and it's patients. There are some water coolers at some stations. There is also a warehouse full of 'sterile water.' So, in an emergency we have plenty of water even though it might get a little expensive if the city water isn't available.
Security. The hospital has it's own security force that is designated as 'Special Police' by the City of Wilmington. Make no mistakes, these people are tough enough but they also have a heart for folks that come to the hospital out of control due to lack of medication or distress. At any rate, they are brave enough to supply a valued service of crowd control if necessary as without a link directly to the police department the hospital would be vulnerable to looting and possibly some real violence when it is realized there are controlled substances within locked areas of each unit and the main pharmacy which is on site.
Electricity. The hospital has a power plant that supplies electricity, especially when there is any interruption of power from outside sources. There are designated 'red outlets' where vital equipment such as ventilators and incubators are plugged 24-7 regardless of the status of the hospital functioning. These items cannot be disturbed in their function. The red outlets have priority over any electricity coming into the facility. There are also backup batteries for lighting in all hallways and there are plenty of flashlights with several dozen sets of batteries for such emergencies.
Authority. No, we don't have a judge and jury. We have holding areas where people can be contained if necessary. The abiding laws of the state, city and federal goverment always apply and that goes for anyone attempting anarchy in any process at the hospital. There are policies within the management that provides for chain of command in making life and death decisions and there is always high ethical standards that apply to any life hanging in the balance. We are first and foremost a hospital and provide care no matter the circumstances.
Last but not least is the structure. The hospital proper if you will. The building is not very different than any high rise. It is akin to any older structure in New York City, but, there are modifications. The building has plates. Expansion plates when it is hot and when the wind outside is at high speed. It sways. It has been measured at one time to sway as much as ten feet or so. The bottom two floors and the top two floors are evacuated to the center floors to allow for any flooding. It is felt those floors are the most vulnerable to the weather and only used when necessary. Nothing tragic has ever happened on any floor of that hospital. And, like I said, the hospital is built on the highest ground in Wilmington. It's considered a safe haven.
So when I ponder the events of Katrina it is with the understanding that floods happen to other cities and especially happen to Wilmington due to hurricanes. No one in this town would take a Cat 5 storm frivolously. Ever. Evacuation would be of utmost importance and done in a timely manner leaving very little opportunity for negligence of safety to the community. The hospital is not to be viewed as a fortress. It is not.
The issue of Katrina cannot be overlooked. The difference between Wilmington and New Orleans Pre-Katrina was preparedness. We don't rely on Wal-Mart to be sure people are provided for and especially those that are hospitalized.
There was no excuse for the negligence of New Orleans or the Gulf Coast, this country has been through it all too often before. Wilmington, North Carolina was a model for Homeland Security LONG BEFORE there was a Secretary Tom Ridge or Michael Chertoff.
In contemplating the events recently of the storm that swept through Wilmington that kept me 'on duty' for nearly 36 hours, I realized how long New Hanover Hospital/Health Network had been doing this without a hitch and I came to terms with the 'blame game' in DC.
Preparedness on the Gulf Coast was never a luxury and yet before Homeland Security existed there was the perparedness of Wilmington, North Carolina. Wilmington did what Homeland Security never did and did it without thinking twice. With a Superstructure like Homeland Security how could Katrina ever have been an issue? There was never a reason for it. Ever. All they had to due was run a laundry list of policies, items, procedures to every hosptial administrator and mayor in the country and follow up with inspections that included successful drills.
That's all they had to do.
They failed those people and left them to die. They left them to hack through roofs to try to find safety and wait for rescue.
There was just no reason for it to happen. Not now. Not after 911. It was all supposed to be planned for and mobilized by a new cabinet level department.
What the heck happened?
