Eye of the storm: Analysis of shelter treatment records of evacuees to Acadiana from Hurricanes Katrina and Rita

Professor of Health Information Management, Director of the Louisiana Center Health Informatics, University of Louisiana at Lafayette, Lafayette, Louisiana.
American journal of disaster medicine 09/2012; 7(4):253-271. DOI: 10.5055/ajdm.2012.0099
Source: PubMed


OBJECTIVE: The objective of this study is to gain insight into the medical needs of disaster evacuees, through a review of experiential data collected in evacuation shelters in the days and weeks following Hurricanes Katrina and Rita in 2005, to better prepare for similar events in the future. Armed with the information and insights provided herein, it is hoped that meaningful precautions and decisive actions can be taken by individuals, families, institutions, communities, and officials should the Louisiana Gulf Coast-or any other area with well-known vulnerabilities-be faced with a future emergency. DESIGN: Demographic and clinical data that were recorded on paper documents during triage and treatment in evacuation shelters were later transcribed into a computerized database management system, with cooperation of the Department of Health Information Management at The University of Louisiana at Lafayette. Analysis of those contemporaneously collected data was undertaken later by the Louisiana Center for Health Informatics. SETTING: Evacuation shelters, Parish Health Units, and other locations including churches and community centers were the venue for ad hoc clinics in the Acadiana region of Louisiana. PATIENTS, PARTICIPANTS: The evacuee-patients-3,329 of them-whose information is reflected in the subject dataset were among two geographically distinct but similarly distressed groups: 1) evacuees from Hurricane Katrina that devastated New Orleans and other locales near Louisiana and neighboring states in late August 2005 and 2) evacuees from Hurricane Rita that devastated Southwest Louisiana and neighboring areas of Texas in September 2005. Patient data were collected by physicians, nurses, and other volunteers associated with the Operation Minnesota Lifeline (OML) deployment during the weeks following the events. INTERVENTIONS: Volunteer clinicians from OML provided triage and treatment services and documented those services as paper medical records. As the focus of the OML "mission of mercy" was entirely on direct individually specific evaluation and care, no population-based experimental hypothesis was framed nor was the effectiveness of any specific intervention researched at the time. MAIN OUTCOME MEASURE(S): This study reports experiential data collected without a particular preconceived hypothesis, because no specific outcome measures had been designed in advance. RESULTS: Data analysis revealed much about the origins and demographics of the evacuees, their hurricane-related risks and injuries, and the loss of continuity in their prior and ongoing healthcare. CONCLUSIONS: The authors believe that much can be learned from studying data collected in evacuee triage clinics, and that such insights may influence personal and official preparedness for future events. In the Katrina-Rita evacuations, only paper-based data collection mechanisms were used-and those with great inconsistency-and there was no predeployed mechanism for close-to-real-time collation of evacuee data. Deployment of simple electronic health record systems might well have allowed for a better real-time understanding of the unfolding of events, upon arrival of evacuees in shelters. Information and communication technologies have advanced since 2005, but predisaster staging and training on such technologies is still lacking.

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    • "Those that depend most heavily on shelters tend to be from otherwise vulnerable populations (e.g., children, elderly, and chronically ill), possess a significant burden of disease pre-event and may be disproportionately impacted physically, mentally, and emotionally by the disaster itself as well as relocation to a novel environment. Despite the proliferation of shelter guidelines post Banda Aceh (2004), Hurricane Katrina (2005), and the Bam, Iran (2003) and Great East Japan (2011) earthquakes, and a growing body of knowledge about resident characteristics , there remains little documented regarding the quality of healthcare provided in disaster shelters (Caillouet et al., 2012; Owens et al., 2005; Takahashi et al., 2012). Following an acute-onset disaster event, the term 'shelter' is most often used to represent the physical structures that are established to provide disaster victims protection from natural elements and also for coordination of health and social services. "
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    ABSTRACT: Globally, shelters are a resource to promote critical health and safety in disasters, particularly for vulnerable populations (e.g., children, elderly, chronically ill). This study examines the nature and quality of healthcare services rendered in disaster and emergency shelters. To determine based upon systematic and accurate measurement the scope and quality of health care services rendered in disaster shelters and to describe the health outcomes experienced by shelter residents. An integrative review of English-language literature pertaining to the assessment, evaluation, and systematic measurement of healthcare quality and client outcomes in disaster and emergency shelters was undertaken. Articles were identified using a structured search strategy of six databases and indexing services (PubMed, CINAHL, EMBase, Scopus, Web of Science, and Google Scholar). Limited literature exists pertaining specifically to metrics for quality of health care in acute disaster and emergency shelters, and the literature that does exist is predominately U.S. based. Analysis of the existing evidence suggests that nurse staffing levels and staff preparedness, access to medications/medication management, infection control, referrals, communication, and mental health may be important concepts related to quality of disaster health care services. A small number of population-based and smaller, ad hoc outcomes-based evaluation efforts exist; however the existing literature regarding systematic outcomes-based quality assessment of disaster sheltering healthcare services is notably sparse. Copyright © 2015 Elsevier Ltd. All rights reserved.
    International Emergency Nursing 01/2015; 23(3). DOI:10.1016/j.ienj.2015.01.004 · 0.72 Impact Factor
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    • "In the immediate aftermath of disaster, subjects are recruited in emergency shelters, community centers, emergency management government centers or health clinics. Retrospective studies can use medical records from this period to describe health issues clinicians faced, before researchers were in the field (Caillouet et al. 2012). Follow-up or longitudinal research into the recovery period brings special issues. "
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    ABSTRACT: Nurses working or living near a community disaster have the opportunity to study health-related consequences to disaster or disaster recovery. In such a situation, the researchers need to deal with the conceptual and methodological issues unique to postdisaster research and know what resources are available to guide them, even if they have no specialized training or previous experience in disaster research. The purpose of this article is to review issues and challenges associated with conducting postdisaster research and encourage nurses to seek resources and seize opportunities to conduct research should the situation arise. Current disaster studies and the authors' personal experiences conducting maternal-child research in post-Katrina New Orleans (2005-2013) provide real-life examples of how health professionals and nurses faced the challenges of doing postdisaster research. After catastrophic events, nurses need to step forward to conduct disaster research that informs and improves future disaster planning and healthcare responses.
    Nursing Inquiry 07/2013; 21(3). DOI:10.1111/nin.12049 · 1.44 Impact Factor
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    ABSTRACT: Introduction Medical history is an important contributor to diagnosis and patient management. In mass-casualty incidents (MCIs), health care providers are often overwhelmed by large numbers of casualties. An efficient, reliable, and affordable method of information collection is essential for effective health care response.Hypothesis/Problem In some MCIs, self-reporting of symptoms can decrease the time required for history taking, without sacrificing the completeness of triage information.Methods Two resident doctors and a number of seventh graders who had previous experience of abdominal discomfort were invited to join this study. A questionnaire was developed to collect information on common symptoms in food poisoning. Each question was scored, and enrolled students were randomly divided into two groups. The experimental group students answered the questionnaire first and then were interviewed to complete the medical history. The control group students were interviewed in the traditional way to collect medical history. Time of all interviews was measured and recorded. The time needed to complete the history taking and completeness of obtained information were compared with students’ t tests, or Mann-Whitney U tests, based on the normality of data. Comprehensibility of each question, scored by enrolled students, was reported by descriptive statistics.Results There were 41 students enrolled: 22 in the experimental group and 19 in the control group. Time to complete history taking in the experimental group (163.0 seconds, SD=52.3) was shorter than that in the control group (198.7 seconds, SD=40.9) (P=.010). There was no difference in the completeness of history obtained between the experimental group and the control group (94.8%, SD=5.0 vs 94.2%, SD=6.1; P=.747). Between the two doctors, no significant difference was found in the time required for history taking (185.2 seconds, SD=42.2 vs 173.1 seconds, SD=58.6; P=.449), or the completeness of information (94.1%, SD=5.9 vs 95.0%, SD=5.0; P=.601). Most of the questions were scored “good” in comprehensibility.Conclusion Self-reporting of symptoms can shorten the time of history taking during a food poisoning mass-casualty event without sacrificing the completeness of information. Y Hsu, YC Huang. Does self-reporting facilitate history taking in food poisoning mass-casualty incidents? Prehosp Disaster Med. 2014;29(4):1-4 .
    Prehospital and disaster medicine: the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation 07/2014; 29(04):1-4. DOI:10.1017/S1049023X14000764