By Sonja Rasmussen, MD, MS
Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital is a non-fiction book written by journalist Dr. Sheri Fink. The book chronicles the aftermath of Hurricane Katrina, when thousands of people were trapped, without power, inside Memorial Medical Center in New Orleans in August 2005.
After reading Dr. Fink’s book I had the opportunity to talk to her about and her thoughts on emergency preparedness. Below we talk about her experience:
Your experiences at Memorial are haunting for me as a public health professional, physician, and acting director of the Office of Public Health Preparedness and Response at CDC. When I read Five Days at Memorial, it was really a reality check as to how critical it is that we ensure that public health departments and hospitals can adequately respond to threats as well as maintain an infrastructure to function during an emergency.
When you first started covering the events at Memorial Hospital, it was for a magazine article. At what point did you realize that this story would span beyond your article?
Fink: The article was 13,000 words, which is pretty long for a magazine. But even that meant leaving out some of the most important details illuminating what had happened in this storm-struck hospital and why. More information came in every day as publication loomed. I kept trying to sneak things in, and the editor said, “Save it for the book.” I realized she was right. These events deserved a book.
What were the biggest lessons learned from the situation at Memorial Hospital?
People who read the book come away with different lessons. One of mine is that whoever’s in the immediate vicinity in a disaster is going to make the biggest difference, and that means we all have a stake in preparedness. I like to think of preparedness on three levels–the infrastructure, the organization and the person. The infrastructure is what blunts the hazard. Keeping infrastructure strong–like retrofitting hospitals for flooding or earthquake protection–can take significant investments. Sometimes those investments can be made in a way that strengthens day-to-day operations. And of course the better things work on a daily basis, the better they would seem to have a chance of working in emergencies.
The organization could be a hospital in this case, but equally a school, a large business, or a government agency. Being prepared has to do with having good leadership, with practicing and drilling for emergencies not just once but regularly, and in partnership with others outside your organization, so that responses are familiar when you’re under stress. It involves prioritizing communications, so that everyone in the organization has information to make the best possible decisions. It involves thinking about supply chains and how they could be impacted. Even something as simple as sleep and shift schedules, and having adequate food and water, can make a huge difference. Also, while it’s natural to want to hide organizational vulnerabilities, being transparent about them helps marshal the support needed to improve on them.
And then there’s that personal level of preparedness, for ourselves and those in our families, communities and professional lives. If you’re a doctor, it could be talking to your patients about their own contingency plans. It’s about a mindset, too–being ready to act creatively without giving up on basic principles. If you’re working at a hospital, and you have responsibility for deciding which patients to prioritize in a crisis, it’s about keeping up the fight for the resources you need to save lives, maintaining “situational awareness” and realizing that frequent reassessment of the needs and what’s available is crucial.
. Memorial showed how difficult questions around resource allocation and end-of-life care–which are with us all the time–can be heightened in a disaster, and walking through what happened there is helpful more broadly when it comes to thinking about these areas.
We all saw what happened after Hurricane Katrina. Do you think we actually learned those lessons, or are we still vulnerable when it comes to emergencies?
We have learned a lot, but our health infrastructure in this country is vulnerable, particularly when it comes to the loss of basic utilities. It’s just a very expensive problem to fix, so it’s not always prioritized, and we depend ever more heavily on electricity in healthcare, from electronic medical records and ordering systems to sophisticated life support systems. The other weekend, I met a nurse whose hospital lost power during a summer storm last month. There was no air conditioning, and then the backup power failed and for four hours she and her colleagues and patients were in Katrina-like conditions, and she said she felt unprepared for it. Hospitals should be gaming this out—“how will you handle orders for medications? How adequate are your battery backups for critical equipment? How will you maintain communications? How will you transport patients down staircases when the elevators don’t work?”
This is important. Think about what we saw after Superstorm Sandy in 2012 in New York City. Flooding knocked out power to hospitals and nursing and adult care homes; chaotic evacuations led to long family separations; and community members with medical needs found themselves trapped in high rise buildings when elevators failed. There was a slowness to grasp the magnitude of the crisis and understand who needed help the most. Still there was a lot of great, lifesaving work among both volunteers and officials who literally hefted food and meals and oxygen tanks up twenty-five flights of stairs for days on end.
Also on the positive side was a story from Bellevue Hospital, the huge public hospital in Manhattan that sits near the East River. On the one hand, the hospital’s electrical infrastructure was vulnerable to flooding, and officials knew they could lose power, and there wasn’t a real plan in place for what to do about that. Still, they acted creatively when the storm surge filled the basement with millions of gallons of water. When the fuel pumps down there failed, someone had the idea to form a human chain and pass containers of diesel up thirteen flights of stairs to where some of the generators were, fueling them directly. They kept partial power going until they could get out even some very difficult-to-transport patients.
If we could go back, before Katrina struck, what do you think was the one thing that would have changed the situation at Memorial?
Getting everyone out before the storm. Of course nobody knows exactly what a storm will do, and there is a risk any time people with complex medical problems are moved. Also, the mayor exempted New Orleans hospitals from his mandatory evacuation order. Still, Memorial’s leaders knew the hospital was vulnerable to losing all power in street flooding of even four feet. They knew the air conditioning wouldn’t work if city power failed. Although the data don’t exist, it stands to reason the risk of harm is greater moving patients during a crisis than moving them in a controlled way prior to losing power. If you have a vulnerability like that and you choose to shelter in place when there’s a reasonable possibility of losing power, then it’s crucial to plan for it. They hadn’t done that. Very few places had.
This year, CDC will focus on Preparedness for Vulnerable Populations during Preparedness Month in September. What do you think Katrina taught us about preparing for those that are the most vulnerable?
It’s essential! Sandy taught us that, too. We know who is most at risk in a disaster. And this is not just an issue for public health officials. It’s everyone’s responsibility to think about our own vulnerabilities and also have in mind our families and apartment buildings and neighborhoods and look out for folks who might be more vulnerable to a disaster.
Sheri Fink is the author of the award-winning New York Times bestselling book, Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital (Crown, 2013). Fink’s news reporting has been awarded the Pulitzer Prize, the National Magazine Award, and the Overseas Press Club Lowell Thomas Award, among other journalism prizes. A former relief worker in disaster and conflict zones, Fink received her M.D. and Ph.D. from Stanford University.