Caring for a Surge of Hurricane Katrina Evacuees in Primary Care Clinics

Hurricane Katrina forced thousands to evacuate the Gulf Coast and devastated health systems in its path, reducing hospital capacity in New Orleans by 80%. Many residents were forced to evacuate without their medication. Cities hundreds of miles away, including Houston, Dallas, and Ft. Worth in Texas, welcomed thousands of evacuees placing increased demands on their health care systems. The paper by Edwards, Young and Lowe describes how JPS Health Network (JPS), a large tax-supported integrated health system in Tarrant County (FT. Worth) responded to the needs of 3,700 Katrina evacuees. Drawing upon the resources of a large family medicine residency program, JPS established a triage center several miles from the hospital and referred almost all of the 1,600 evacuees seeking medical care to a primary care clinic, thus preventing a large increase in demand for emergency department and hospital services. The JPS model may have wide applicability in similar circumstances and offers at least three important lessons for emergency planners: First, large regional disasters may require massive evacuations and thus impact health systems in distant cities.Some evacuees will travel in their own vehicles and may present at emergency departments for routine care. However, many may be transported by air or bus and for these groups the triage and primary care clinic model is well suited. Regional disaster plans should account for the possibility of an influx of large numbers of evacuees as well as local disaster victims. Second, it is widely recognized that hospitals and emergency departments are likely to be overwhelmed in a mass-casualty incident and that many of the patients who present at these facilities may not require emergency care. Off-site triage and primary care sites can address non-urgent needs while preserving scarce hospital and emergency department capacity for the most serious cases. The JPS model provides an excellent example of this process under favorable circumstances (large numbers of transported evacuees and time to prepare). Planners should consider a similar approach where conditions and resources allow. Finally, the family medicine residency program provided JPS with the in- house physician surge capacity to respond to the needs of evacuees with minimal disruption of routine operations. Many hospitals and health systems do not have similar resources available, but where they exist, family medicine residency programs can be valuable partners in health system preparedness. The broad medical education of family physicians make them ideally suited to provide triage, as well as primary care, to evacuees and local disaster victims. When this can be accomplished away from hospital campuses it can relieve the burden on vital emergency departments. Emergency planners should work closely with these programs to ensure they are incorporated in regional disaster response planning.

Wayne Higgins, PH.D Professor of Health Service Administration Western Kentucky University

Competing interests:   None declared

Edwards et.al. (1) offer a valuable contribution to the disaster literature with their discussion of a healthcare system's response to arriving evacuees from Hurricane Katrina. A few points are worth emphasis:

1. Outstanding partnership was exhibited between county emergency management and the JPS healthcare system. Estabilishing these relationships in advance of any incident is important to timely and appropriate use of primary care resources.

2. The JPS system was able to access and deploy a wide range of resources to both traditional and non-traditional locations to support the response effort. This institutional commitment and the flexibility and scalability of the response are admirable.

3. Primary care skills are far more important in disasters than is commonly appreciated. This is of particular importance when the disaster results in loss of healthcare infrastructure in the affected area and/or is an infectious disease event affecting the community. Planning to incorporate primary care outpatient practices and staff into community plans can literally make or break a disaster response.

4. Though healthcare disaster planning efforts to date often focus on inpatient surge capacity (2) there is no true community surge capacity for disasters without the involvement of primary care (and other outpatient clinics) and their staff.

5. Supply planning for disasters often concentrates on medications and supplies to be administered in hosptial environments. Greater emphasis is needed on stocking adequate outpatient medications including analgesics, anti-hypertensives, antibiotics, insulin and oral diabetes control agents, bronchodilators, and other commonly used medications.

This article should stimulate needed discussions and planning with practice colleagues, local emergency management, hospitals, and parent healthcare corporations to determine the roles and responsibilites of primary care practictioners in local disaster response to assure their optimal utiliztion for the community's benefit.

1. Edwards TD, Young RA, Lowe AF. Caring for a surge of Hurricane Katrina evacuees in Primary Care Clinics, Annals of Family Medicine, March/April 2007;5(2):170-4. 2. Hick JL, Hanfling D, Burstein JL, et al. Health care facility and community strategies for patient care surge capacity. Ann Emerg Med. 2004;44(3):253–261

Competing interests:   None declared