Vulnerable Populations and Public Health Emergencies

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Vulnerable Populations and Public Health
Emergencies
LuAnn E. White, PhD, DABT Tulane Center for
Applied Environmental Public Health November 4,
2006
Lessons from Hurricane Katrina
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Hurricane Katrina August 29, 2005
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Preparedness --- or lack of..
Evacuation of New Orleans Area
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Some did not leave..
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Why dont people leave??

• Experiences Dont see danger or been through
  other bad storms
• Dont believe officials Cry wolf
• No money to travel (end of month)
• Too much traffic
• Wont leave pets
• No transportation
• (20 without vehicles)

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Of those who stayed.

• More likely to be
• In Poverty no transportation or no money
• Elderly experience with
• hurricanes not up to traveling
• Sick and disabled
• too ill to travel
• risk of moving vs danger

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New Orleans Survived the Storm
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But not the Levee Failures
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Hurricane Katrina and New Orleans
September 2, 2005
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Rescue
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Human Tragedy
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80 of the city flooded
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Poverty and Evacuation

• 27 of New Orleans below poverty level
• Those in poverty less likely to evacuate
• Sought refuge in Superdome
• Evacuated and dispersed
• across the county
• Houston took refugees

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Evacuees in Houston Astrodome

• 14 physically disabled
• 22 physically unable to evacuate
• 23 stayed to care for someone
• 25 had a chronic disease
• Cardiovascular disease
• Diabetes
• High blood pressure

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Mortality

• Death toll (La) gt 1464 people
• 853 Bodies recovered in LA
• 480 Died in other states (8/29/05 to 10/1/05)
• Race
• 53 African/American
• 40 White
• 2 other
• 5 unknown
• Age
• 60- 74 years 23
• 75 years 45

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Mortality Emergency Phase

• 584 Elderly died during emergency phase
• Elderly died in homes before rescue
• Heat stress in attics
• Cardiovascular events
• Nursing Homes
• 215 died in nursing homes

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Nursing Homes and Long Term Care

• 280 Nursing Homes
• 78 did not evacuate
• Lack of planning
• Transportation issues
• Cost/ no reimbursement
• Few places to take residents
• Serious illnesses and chronic diseases
• Risk of travel vs danger

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Hospitals

• 22 hospitals
• 12,000 patients
• 24,000 staff and families
• Released non-critical patients
• Planned short term sustainability
• Generators and Emergency supplies
• Issues in palliative care

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Longer Term and Mortality

• In 6 months following Katrina
• Increased deaths in elderly
• Mental and physical stress
• Stress of evacuation chronic illnesses
• Loss of homes and resources Not able to rebuild
• Loss of independence must live with others
• New Environment and loss of social networks
• He died of a broken heart

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Lessons Learned

• Emergency Response and Evacuation
• Need for organized plan for people with no
  transportation and special transport needs
• Shelters and places for people to go
• Allow pets in shelters
• Plan for hospital evacuation or support during
  disasters When to evacuate
• Plan for nursing home evacuation
• Family and friends plan for evacuation of elderly
  and disabled

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Still Learning Lessons

• Recovery Phase
• Long term displacement Issues
• Poor more likely to be displaced
• Elderly and seriously ill more likely to die
  during disaster and evacuation
• Lack of health care
• Loss of physicians, clinics and hospitals
• Housing
• Low and moderate priced housing needs

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We survived
Come on down