Case Study 2
Strengthening the Actions of Public Health Officials, Emergency Response Personnel, and Law Enforcement during a disaster on the U.S. Gulf Coast
Based on Hurricane Katrina, New Orleans, LA
Objectives/ Topics for the Case Study
1. Clarify the roles of federal, state, and local governments in emergency management and the contribution of community partnerships
2. Describe the legal role of public health agencies in a declared state of emergency
3. Describe a public health agency’s legal authority and role during a mass evacuation
4. Understand public safety, security, and provision of public health services of displaced populations
Background
Hurricane Katrina made landfall in Plaquemines Parish, Louisiana on Monday, August 29, 2005 at 6:10 am CDT as a powerful Category 3 storm. Before colliding with the Gulf Coast, Katrina generated violent waves and a massive storm surge. A storm surge as high as twenty-seven feet in Louisiana and Mississippi was recorded by the National Oceanic and Atmospheric Administration (NOAA). The communication infrastructure along the entire Gulf Coast was devastated by Katrina, affecting telephone services, police and fire centers, and emergency response radio systems. One of the areas in the path of the storm was the City of New Orleans. Katrina caused extensive damage to high-rise buildings, communities, and the Louisiana Superdome - where more than ten thousand people took shelter. Primary and secondary sources, sewerage and draining services, and power lines were completely incapacitated, causing an incredible health concern for the communities affected. Mayor Ray Nagin reported that, due to the devastated communication system, local, state, and federal officials were forced to depend on a variety of conflicting media, government, and private reports. The National Weather Service (NWS) received a report of a breached levee on August 29th, as early as 9am, and shortly thereafter issued a flash flood warning. On August 30th, by morning light, the extent of the flooding was evident. In the days to come local, state and federal agencies were faced with countless challenges including, public safety and health, evacuating of millions of people, restoring water supplies, inland flooding, power outages, and unreliable communication systems in the aftermath of Hurricane Katrina.
Question 1: Under what legal authority, who can declare an emergency?
Under the authority of the Robert T. Stafford Disaster Relief and Emergency Assistance Act (the Stafford Act), only the President of the United States may declare that a major disaster or emergency exists. The declaration process is initiated when the Governor of the affected state requests a declaration through the regional FEMA/EPR office. The request for declaration must demonstrate that available state and local resources are insufficient for the given disaster scenario.
Monday, August 29: “Landfall”
The storms eye passes eastern New Orleans at around 8am. FEMA director, Micheal Brown, arrives in Baton Rouge in late morning to find water already coming over levees along 9th Ward and reports of compromised levees in the Industrial Canal and 17th Street Canal. Rising floodwaters are causing concern as winds continue to cause damages to buildings and communities. The Jackson Barracks of the Louisiana National Guard flood. Louisiana and Mississippi are declared major disaster areas by President Bush. Major Ray Nagin states that he did not see Brown for the first couple of days.
Question 2: What constitutes a public health emergency?
Section 319 of the Public Health Service (PHS) Act grants the secretary of the Department of Health and Human Services (HHS) the authority to declare a Public Health Emergency (PHE). A PHE declaration may be granted in response to a disease or disorder, outbreaks of infectious disease, or bioterrorist attacks.
Tuesday, August 30: “Day two”
Attempts to plug breaches in the 17th Street Canal and Industrial Canal levees by the Army Corps of Engineers failed. Flood waters continue to rise. Search and Rescue commences, hundreds rescued on day two. Complaints from emergency responders and public health officials come in that communication links are extremely poor. More individuals seek shelter, food and drinking water. Governor Kathleen Blanco announces that the Superdome, housing tens of thousands, should be evacuated after water surrounding it begins to rise. Mayor Nagin expresses his concern to the President and Governor.
Question 3: To call for an evacuation or a shelter-in-place order, what legal and operational considerations might influence this decision?
Before a declaration of evacuation is issued many factors must be considered. Some legal considerations that must be taken include the balance between the risks and benefits of the proposed evacuation. Clarifying the chain of command is another legal consideration that may influence the decision initiate an evacuation or a shelter-in-place order. Finally, identifying the authority for action must be taken into consideration.
The degree of hazard, evacuation routes, available transportation, characteristics of the affected population (i.e., number of households without access to a vehicle), and capacity to evacuate are a few of the operational issues that must be considered when deciding to order an evacuation or shelter-in-place. In addition, household pets and service animals should be considered. The threat/type of emergency and the jurisdiction in which it is occurring plays a significant role in the decision making when considering to issue an evacuation or shelter-in-place order.
Wednesday, August 31: “Day Three”
Governor Blanco orders an evacuation of the City of New Orleans due to rising waters and uninhabitable conditions. Search and rescue was made the top priority, especially from medical facilities (i.e., hospitals) and areas that were hit the hardest. Walter Maestri, Jefferson Parish Emergency Manager, is not convinced that FEMA or the state is providing enough support/assistance in the appropriate amount of time.
Question 4: Are the requirements for the evacuation of individuals with special needs and the elderly different?If so, how are they addressed through an evacuation or shelter-in-place order?
The reality is that during an evacuation those that are at greater risk include the elderly, those with special needs, those with a language barrier, and disadvantage populations. This operational reality will not only affect the decision of whether or not to evacuate or shelter in place –it will affect whether special precautions or legal obligations need to be taken. The protections and requirements provided by the Americans with Disabilities Act and all other applicable anti-discrimination laws must be respected during an evacuation. In the case of the elderly and those with special needs, pre-event planning is essential. Decision-makers must carefully consider the needs of these individuals, as well as the potential risks and benefits that may result from an evacuation. In addition, specific characteristics of the shelter location such as accessibility, space for assistive devices, and adequate resources, supplies, and expertise for special health care needs should be evaluated.
*Post Katrina Emergency Management Reform Act (PKEMRA) requires the appointment of a Disabilities Coordinator to ensures that the needs of special needs populations are addressed during an emergency (CDC Public Health Emergency Law Case Study)
Question 5: Should evacuation be mandatory or voluntary? What factors must be considered? Who will enforce evacuation?
Voluntary Evacuation: Individuals are not required to evacuate even though they have been given a warning that the area has been designated life threatening or at risk of danger in the immediate future.
Mandatory Evacuation: Individuals must vacate area in accordance with the instructions of local officials once given warning that the area poses a threat to life and property.
When considering a voluntary vs. mandatory evacuation it is important to take multiple factors into consideration. Some of which include, the number of individuals that are affected, the available resources for evacuation, degree of hazards pre and post evacuation, characteristics of the population at risk, available transportation for evacuees and safe routes.
Evacuations may be enforced by multiple entities including the emergency response services, law enforcement (i.e., police), and the National Guard. Public health officials must provide law enforcement agencies with clear guidelines that include legal authority on the issue of enforcement of evacuation in order to avoid any tension with respect to authority and the actions that are necessary.
Saturday, September 3: “The Day the Calvary Arrives”
After a meeting on Friday, September 2nd, President Bush sent in 4,600 active duty troops at the request of Governor Blanco and Mayor Nagin. Buses begin arriving to evacuate over 25,000 people from the convention center. Many are still trapped by floodwaters and emergency calls are starting to come in.
Question 6:What are the roles of local, state and federal governments during this state of emergency? What are the roles of public health agencies in a declared state of emergency?
The following is according to The Federal Emergency Management Agency FEMA guidelines:
Local
At the local level, the government should maintain control of all assets being used regardless of the source of those resources. The role of the local government should be strengthened through the support of both the Federal and State government. The local response personnel serve as the “primary providers” of emergency response services. They should be responsible for activating the Emergency Operations Center (EOC) and implementing their existing Emergency Management Plan. Coordinating the response with public and private entities is crucial. Activating all local resources at their disposal, notifying the State Emergency Management Agency, and activating response agreements with State and Federal departments or agencies are also key components of the local response to a disaster. The local government is also responsible for proclaiming a local state of emergency to authorize the use of local resources, expending local funds, waiving the usual bidding process for goods and services, and asking for State and/or Federal assistance.
State
State assistance is requested after the local government has exhausted all local resources. If federal assistance is required, the state governments serve as agents for local jurisdictions. State response includes the following: monitoring of the situation, reviewing and evaluating local response efforts and requests for assistance, activating the state EOC to coordinate available state assistance, determining if the situation requires federal assistance, proclaiming a state of emergency by the governor, and requesting federal assistance as needed.
Federal
The federal government becomes the source of resources if the local and the state governments cannot provide the necessary resources to respond to a disaster. Federal response functions may include conducting joint preliminary damage assessments with state and local governments, reviewing requests for federal assistance, providing immediate response assistance, and identifying the necessary Emergency Support Function (ESF) to respond (Table 1).
Table 1: Roles and Responsibilities of the ESFs
*Table 1: 0604/emergency_support_function_annexes_introduction_2008_.pdf
Question 7: Does pollution created by hurricanes pose a threat to public health and the Gulf? What are health risks associated with natural disasters (i.e., hurricanes)?
The Gulf of Mexico is an important region for oil and gas production and refining. When exposed to the disruptions that may result from hurricanes, the energy infrastructure located in and around the Gulf may serve as a potential source of pollution. Damage to vessels, oil drums, and other containers holding hazardous materials can introduce pollution that is detrimental to both human health and the environment.
The immediate health risks associated with natural disasters may include physical trauma due to falling debris, drowning, burns, and exposure to toxic substances. Exposure of open wounds to contaminated waters can lead to infections such as tetanus. In addition, water systems may become contaminated, damaged, or disrupted as a result of a natural disaster. Exposure and ingestion of contaminated drinking water may lead to water-related communicable diseases such as Vibrio cholera. Overcrowded shelters can also increase the rate of communicable disease transmission. Vector-borne diseases may also arise if the conditions subsequent to a natural disaster promote insect breeding.
Tuesday, September 6: “Day Nine”
A “total evacuation” of New Orleans is ordered by Mayor Nagin due to the dangers and health risks posed by the contaminated standing water. The Army Corps of Engineers were able to repair the breaches in the 17th Street and Florida Av Canals. Power is restored to the Warehouse and Central Business Districts and telephone service is back for half of the city. The ACE projects that the pumping of water from the city may take more than 80 days.
Question 8: What steps are being taken to prevent the outbreak and spread of viral and bacterial illnesses in shelters?
Sanitation measures and stressing good personal hygiene practices are key to preventing the spread of viral and bacterial diseases in shelter settings. Hand washing is an effective infection prevention measure that should be used by all staff and evacuees. If running water is not available, alcohol hand gel should be supplied and placed around the shelter facility. Public Health authorities should encourage occupants to wear masks if they are sick, think they may be getting sick, and/or during coughing and sneezing.
Shelter occupants should be discouraged from sharing eating utensils, drinking containers, or personal toiletries such as toothbrushes and combs. Adherence to good hygienic practices during food preparation and proper disposal of waste are crucial for preventing the spread of disease. In addition, shelter facilities should be sufficient to allow evacuees to bathe at least twice a week and to launder clothing and bedding.
Shelter occupants should receive a flu vaccine and a vaccine for Hepatitis A, since the transmission of these diseases is more common in crowded evacuation centers.
Question 9: What medical services are currently offered to assist hurricane victims?
The U.S. Health and Human Services is responsible for setting up and overseeing relief efforts with the regional hospital council. The implementation of mobile clinics during the aftermath of natural disasters is extremely beneficial, especially for immunocompromised and/or underserved individuals. During natural disasters (i.e., hurricanes) high-risk, high acuity disease patients are the focus of the National Institutes of Health.