Threats That Face Our Nation and Viable Solutions - Medical Perspective

Threats That Face Our Nation
and Viable Solutions -

Medical Perspective
Paul K. Carlton, Jr., MD, FACS
Lt. Gen, USAF, Ret
Director, Homeland Security
The Texas A&M University System
Health Science Center
12 September 2005
Office of Homeland Security
The Texas A&M University System Health Science Center
Overview
•Threat
•Solutions
•Katrina

Worst Nightmare
Lose whole local

health care
network!
Katrina
Disaster Preparedness:
It’s All About Me!
Three deadly misconceptions:

1. It will not happen here!
2. It will not happen to me!
3. Someone else will be there
to take care of the problem!
Jay A Johannigman
Crit Care Med Vol 33, No1
LEARNERS
“In a time of drastic change it
is the learners who inherit
the future. The learned
usually find themselves
equipped to live in a world
that no longer exists!
Eric Hoffer

LEARNERS
ALL OF US
MUST BE
LEARNERS!

Don’t be learned!

You may obtain a copy of this
presentation at:
www.tamhsc.edu/homeland/

America is in
Danger!

Danger Always Present,
Just Beneath the Surface

Facing Reality is Difficult
None of us
Want to Face
What Lies
Ahead of Us
We Must!

Change Is Hard
“Every revolutionary idea evokes

three stages of reaction”
1.You’re nuts!
2.It would work, but no reason to
change!
3.You like it? – It was MY idea!

Response
Chain

Response Chain
LINKS:
•Prevention
•Mitigation
•Consequence
Management
•Recovery
Response Chain
All of these have some part of the

response chain-
•Police
•Fire
•EMS
•Medical

Weak Link
Medicine may
be the
Weakest Link!

Response Chain
It all comes to life

or death!

Response Chain
IT’S ALL ABOUT PEOPLE

Not about bricks or lumber in
a pile, not about concrete
destroyed
It is the dead and injured.
“Medical Must Be
Considered”
Weak Link
“We could see collapse of our

health care system in any bio
event!”
Chuck Ludlam, Chief of Staff
Senator Lieberman
15 April 05

Weak Link
“We are totally unprepared medically!”
“We have none of the vaccines nor
antibiotics that we would need in a bio
event.”
“Defense Contract model will not work in this
situation.”
Chuck Ludlam, Chief of Staff

Senator Lieberman
15 April 05
Weak Link
“Medicine is our weak link

and that is where we will
break.”
Ed Eberhart
CINC – NORTHCOM
May 3, 2004

These people could be wrong
but
I doubt it

Medical Response
Why?
95% 95%
Public Private
Police
Fire Medical
EMS Capabilities
Different worlds – they do not understand each other

Medical Response
95% 95%
Public Private
Police
Fire Medical
EMS Capabilities
Different worlds – they do not understand each other

Medical Response
NO OWNED ASSETS
•ALL PRIVATE
REQUIRES BETTER COOPERATION
and UNDERSTANDING THAN WE
HAVE EVER SEEN!

Threats
95%
Private
Medicine, as
we know it, is
in danger of
Medical
Capabilities failing.
The Current Hospital
Environment
• Key component of consequence management is timely medical
care for victims of mass casualty incidents
– Incorrect assumptions made about existing medical
capabilities to treat mass casualties
• Hospital surge capacity has never been more restricted
– Medical community struggling just to
maintain everyday capacity
• Majority of preparedness issues are
financially (revenue vs cost) based
• “Without prompt action, the nation carries the risk that
victims of a mass-casualty disaster might end up in ‘ambulances
to nowhere’."
Source: Barbera, Macintyre, and DeAtley
Mar 2002
Ambulances to Nowhere
• Funding shortfalls
– Decline in government support for public and private
hospitals
– Increasing number of expensive, unfunded, or under-funded
regulatory mandates
– Continued expectation that hospitals will maintain high
levels of charity medical care
– National shortage of nurses for acute
care hospitals, resulting in need for special
compensation packages to attract personnel
• Results -- closure, downsizing, consolidation,
reconfiguration, and partnering
– Abolition or downsizing of specialty services crucial to
disaster preparedness! Source: Barbera, Macintyre, and DeAtley , Mar 2002

• Delivery of acute medical care evolved beyond ordinary business

relationship to "trust" with patients
• “Trust” has extended to current threat environment
– Move from individual patient to community as a whole
– Financial support to hospitals by community create expectation
hospitals will address community's health/medical needs, including
disaster preparedness
– Reasonable cost for hospital preparedness for mass casualties
was assumed to be necessary cost of doing business
• Financing costs
– Old – Medicare and fee for service
– New – Managed care payment system (capitation)
• Bottom line: Disconnect between expectations and funding!
Source: Barbera, Macintyre, and DeAtley , Mar 2002
Troubled Medical System
• Growing concern over projected shortage of healthcare
providers in coming years
– Other factors: aging population, increased demand, and
increased costs
– Troubled specialties -- orthopedics, radiology, dermatology,
cardiology, ophthalmology and anesthesiology
• Bleak future forecast
– Shortage of 200,000 doctors,
– 157,000 pharmacists
– 20% shortfall in nursing
– requirements by 2020
Kiplinger, Mar 05
– Quality of life greatest deterrent
A Strained System
• Hospital capacity continues to be main limiting factor in disaster
medical response
– Critical care services and intensive care units most affected
• Recent examples
– Only 25 ICU beds usable for 27 patients in Madrid bombing
– Only 12 ICU beds available for 20 patients in Bali bombing
– 2001 Houston floods reduced ICU capacity by 75%
• More challenges
– Toxic chemical scenario: 1200 bed hospital could handle only two
patients at one time
– Poor staffing levels for critical care areas
Dara, Ashton Farmer, Feb 05

A Strained System
• Possible “surge” solutions

– Pre-emptive education – Increased disaster response awareness,
improved skill sets, comprehension of roles and responsibilities,
alternate communication styles, and expertise in cooperation
during chaos
– Interfacility cooperation – Creation of flexible
plans for interchanging resources to supplement
existing capacity of hospitals
– Dual usage of resources – Critical care
units respond outside geographical
locations; merge training and education

A Strained System
“It’s an unsustainable situation. Without

some major fix… this system will self-
implode.”
Ted Epperly, M.D., Board Member
American Academy of
Family Physicians

A Strained System
These are the facts!

“Everyone is entitled to his
opinions. He is not
entitled to his own facts!”
Senator Daniel Patrick Moynihan, NY

Modular Medical Response Capability:
A Possible Future
Local Infrastructure Baseline Aeromedical

Capability Evacuation
Federal
Units of QRP
Medical
Capability
Regional Center Response
(NG and AHC Medical Center led)
Emergency Room
Day to Local Response Operating Rooms
Day ICU Beds
Patient Inpatient Beds
Capacity Physical Space
Time
A Possible Future

Disaster
Occurs!
Federal
Units of QRP
Medical
Capability
Emergency Room
Day ICU Beds
Time
Tools
Must have response units to solve problems
Requires “Tools in the Toolbox”
NO Tools
NO Response

Means military-civilian cooperation!
And
Civilian- civilian cooperation!
5 P’s
1. Prior
2. Planning
3. Prevents
4. Poor
5. Performance
TEAM

Preparation for the Nation
Making the Pieces Fit
First Public Health Course
Trauma & Critical Care
Pararescue Course
First
Receivers Bio-Terrorism Course Preparers
Trauma & Disaster Course
Mental Health Aspects Course
Trauma & Critical Care
Pararescue Course
Public Health Course
Eye Trauma Course

WE
Trauma & Disaster Course
Critical Infectious Diseases Course
Bio-Terrorism Course
Critical Care Transport
Bio-Terrorism Course
Public Health Course
First
Trauma & Dusaster Course
Responders
All Hazard

Forward Operation Base Marez
Mosul, Iraq
24 December 04

Forward Operation Base Marez,
Mosul, Iraq
12:15 pm – Explosion in dining facility

Evacuation begins
12:25 pm – 12 casualties arrive at
medical facility
Medical Fights On
To Save Lives
Forward Operation Base Marez,
Mosul, Iraq
12:25 pm Triage begins

12:40 pm Mortar attack hits hospital
Hospital “hard” and no casualties
Full speed for 12 hours
11:30 pm Breath
2:00 am CCATT’s arrive- medical “tune up for flight”
4:00 am CCATT’s fly away – 12 patients to Germany

Statistics
9 OR cases
91 patients 7 Open laparotomies
10 surgeries in hallway
18 DOA
8 pts – mechanical ventilation
4 DOW
14 chest tubes placed
69 left 39 CT scans done
20 to other military 200 plain radiographs
hospitals 294 lab tests
49 to treat 40 units of blood products
217 IV meds given

Statistics
9 OR cases
91 patients 7 Open laparotomies
10 surgeries in hallway
18 DOA
8 pts – mechanical ventilation
4 DOW
69 left
Good Job 14Army!
chest tubes placed
39 CT scans done
20 to other military 200 plain radiographs
hospitals 294 lab tests
49 to treat 40 units of blood products
217 IV meds given

A Busy Day
• Attack by suicide bomber on food tent in Forward Operating Base

Marez created numerous casualties
– 91 casualties in 11 hours
– 22 died in attack; 18 were American
– 17 dead on arrival; 5 with nonsurvivable wounds
• A busy day for casualties…
– Highest number of casualties treated at
military hospital in Iraq during war
– 9 surgeries performed in OR; 10 performed outside OR
– Mortuary established in parking lot
NY Times, Dec 04

Standard of Care/
Sufficiency of Care
“Sufficient
Demands
care”
“Standard of
Care”
Care Capability
Standard of Care/
Sufficiency of Care
“Sufficient
Demands
care” 10 surgeries
Smooth transition in hallway
“Standard of 7 Open laparotomies

Care”
9 operations in OR
Care Capability
The interface of standard of
care and sufficiency of care
Graceful Degradation
of Care
Care Standards
GOLD STANDARD
???
“Plan B” Operations
Demand
MORAL IMPERATIVE

Lessons learned for U.S. from this
• Triage needs work

•Training saves lives
•Resource allocation is critical!

Must have graceful degradation of
care well planned
of Care
Care Standards
GOLD STANDARD
???
Demand
MORAL IMPERATIVE

A Change in Standards
• Popular belief health care organizations/public health agencies

structured to handle surge
– Wrong! Terrorist attack could compromise current system
• We must identify, plan, and prepare to make adjustments in current
health and medical care standards!
– DHS and several key agencies recently met to discuss U.S. ability
to respond to attack
• Purpose of meeting:
– Examine current standards
– Recommend specific actions for Federal,
State, regional, community, and health systems planners
Health Systems Research, Aug 05

What to Address?
• Critical questions discussed
– What knowledge must planners possess to develop effective
health and medical care response plans to mass casualty event?
– What key principles guide planning for health/medical response
to mass casualty event?
– What issues must be considered/addressed
in planning for health and medical care in
mass casualty event?
– What information, tools, models, and other
resources are available to address planners’
needs?

The Results
• Key findings
– Goal of mass casualty response -- maximize number of lives
saved
– Must change process to allocate scarce resources
– Many health systems do not provide adequate planning and
guidance to direct change in current standards
– Allocating health and medical resources in a mass casualty event
should be fair and equitable
– Protocols for triage based size and nature of event and speed of
development
– Must have adequate number of staff, equipment, and
pharmaceuticals on hand for any event

What Next?
• Proposed actions
– Develop overarching/specific guidance for distributing scarce
health and medical care resources during mass casualty event
– Develop and implement method to address nonmedical (i.e.,
finance, communication,etc.) issues during event
– Develop strategy for risk communication for public
– Develop practical tools for medical personnel
– Develop strategies for leadership/coordination on-site
– Continue/expand response personnel training
– Develop Community-Based Planning Guide for Mass Casualty
Care for planners

Mass Casualty Events
Man Made
Natural

?Not Applicable?
•I will never see that number of

casualties
•I don’t have to worry about
these things!
COMMON COMMENTS TO ME!

Complaints
without
Solutions =
Whining
SOLUTIONS
Currently under way at A&M Health Science Center
1. Education and Training

2. Menu Brief 12. Incentives – “Carrot
3. Medical Student Education Credentials”
4. Leadership Program for 13. Medical Operations
Disaster Response Center Proposal
5. Master Plans 14. NORTHCOM
6. Plan “B” 15. Diabetic Retinopathy
7. Triage Screening
8. Mobile Solutions 16. Isolations Rooms
9. “Surge” Hospitals or 17. Scancorder
Community Health Centers 18. Ventilators
10. Veterinary School “Surge” 19. Hospital Flow
Hospital
11. VA Proposal
7 April 05
Texas A&M University System
Austin, Texas
How to Build a
“Surge Hospital for a Song”
Austin, Texas
August 2005
This Plan Protects
•Staff
•Patients
•Victims of MCI
•State Capitol
•Football Stadium
Requirement by Department of
State Health Services
112 Bed “Surge” Facility

“in place”
St. David’s requirement from
the DSHS as fair share for
Austin community
The Red Wedge Concept
“Plan B”
“Sufficient
At some point we will go
care” to “sufficient care” , not
“standard of care”
Demand
Soft sided solutions may apply
“Standard of Surge from outside sources

Care”
Peacetime Surge - within
Care Capability
of Care
Care Standards
GOLD STANDARD
This plan stays within SOC
Double the numbers moves to Sufficient Care

???
Demand
MORAL IMPERATIVE

Entry
Dec
ont
ami
nat
io n
I
Sequence:
1. Notification of MCI D M
2. Decon and Triage
prepared
3. Day surgery empties
E
4. Opens beds for MCI
Key
1. Control hospital
2. Not allowed into facility until decon is
done
3. Allow time for preparation of day surgery
for mass casualty incident (MCI)
4. Allows isolation from rest of facility
5. Central to downtown
Photo by: Salvador Monastra-SeBasoc
St. David’s Safety Officer

Flow Pattern in Triage Area
Dec
ont
ami
nat
io n
te
edia
Imm al
Sequence: ini
m
M
1. Notification of
MCI e l aye
d
D
2. Decon and Triage n t
ecta
Exp
prepared
3. Day surgery
empties
4. Opens beds for
MCI
Triage entirely
dependent on
resources and load
from MCI

Whole separate HVAC system protected by Isolate Filter
Day surgery patients go
straight to central Sequence:
hospital 1. Notification of MCI
Immediate
RX area
2. Decon and Triage
To O prepared
R 3. Day surgery empties
4. Opens beds for MCI
Hold
ICU
ing b
ds e
Photo by: Salvador Monastra-SeBasoc

St. David’s Safety Officer

The Red Wedge Concept
“Plan B”
“Sufficient
At some point we will go
care” to “sufficient care” , not
“standard of care”
Demand
Soft sided solutions may apply
“Standard of Surge from outside sources

Care”
Peacetime Surge - within
Care Capability
of Care
Care Standards
GOLD STANDARD

???
Demand
MORAL IMPERATIVE

The Battle of New Orleans
2005
Not January 1815
But
August 2005
The Battle of New Orleans
2005
Medical Perspective

KATRINA:
A Rain of Terror

• Funding shortfalls
– Decline in government support for public and private
hospitals
– Increasing number of expensive, unfunded, or under-funded
regulatory mandates
– Continued expectation that hospitals will maintain high
levels of charity medical care
– National shortage of nurses for acute
care hospitals, resulting in need for special
compensation packages to attract personnel
• Results -- closure, downsizing, consolidation,
reconfiguration, and partnering
– Abolition or downsizing of specialty services crucial to
disaster preparedness! Source: Barbera, Macintyre, and DeAtley , Mar 2002

• Delivery of acute medical care evolved beyond ordinary business

relationship to "trust" with patients
• “Trust” has extended to current threat environment
– Move from individual patient to community as a whole
– Financial support to hospitals by community create expectation
hospitals will address community's health/medical needs, including
disaster preparedness
– Reasonable cost for hospital preparedness for mass casualties
was assumed to be necessary cost of doing business
• Financing costs
– Old – Medicare and fee for service
– New – Managed care payment system (capitation)
• Bottom line: Disconnect between expectations and funding!
Source: Barbera, Macintyre, and DeAtley , Mar 2002
A Strained System
• Possible “surge” solutions

– Pre-emptive education – Increased disaster response awareness,
improved skill sets, comprehension of roles and responsibilities,
alternate communication styles, and expertise in cooperation
during chaos
– Interfacility cooperation – Creation of flexible
plans for interchanging resources to supplement
existing capacity of hospitals
– Dual usage of resources – Critical care
units respond outside geographical
locations; merge training and education

Jim Lehrer Newshour – 8 September

Blame Amid the Tragedy
by Bob Williams
“Who is to blame for the inadequate response?”

“The primary responsibility for dealing with
emergencies does not belong to the federal
government. It belongs to local and state officials
who are charged by law with the management of
the crucial first response to a disaster.”
Source: opinionjournal.com
7 September 2005

by Bob Williams
Hurricane Katrina - New Orleans – September 2005

•Failure of implementation of established evacuation plan by Gov.
Blanco and Mayor Nagin
•Problems that were identified in hurricane simulation in October
2004 were not corrected
•New Orleans contingency plan that states: “the safe evacuation of
threatened populations is one of the principle reasons for
developing a Comprehensive Emergency Management Plan”
PLAN WAS APPARENTLY IGNORED

7 September 2005

by Bob Williams
•“The federal government does not

have the authority to intervene in a
state emergency without the request
of a governor.”
•“It must be made clear that the
governor and locally elected officials
are in charge of the “first response.”
7 September 2005

Hurricane Katrina

Medical Victory Due to:
• Ingenuity
• Dedication to patient care
• Volunteerism
• Good planning!

Good
1. Waiver of Louisiana license
2. Surge
3. Regional and national plan
4. Thinking about this for long term
5. Exercises 2004 and August 2005 – levees failed
6. Attitude
7. Strike team into Baton Rouge day #1
8. Member of National Disaster Life Support
(NDLS) consortium – so well educated
Bad
1. Communication
2. Transportation
3. Deaths
4. Complacency to sit through the
storm
5. Lack of execution of evacuation
plan
Ugly
1. Lawlessness
2. Chaos
3. Looting
4. Media

Katrina Timeline
8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Tues Wed Thurs Fri Sat Sun Mon Tues Wed Thurs Fri Sat Sun Mon Tues Wed
The Story Does Not Start Here

Story Begins
Begin 4 years ago with National Disaster Life

Support Consortium (NDLSC) first formed –
LSU charter member
2001 - 2005 DLS family of courses written and
given to thousands, including LSU and Baton
Rouge
-medical
aspects of disaster
management and care
Katrina Timeline
8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7

Katrina Timeline - 23-27 August
8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
23 - 27 Aug tropical storm Katrina strengthens into Hurricane Katrina and hits
Florida. It then weakens and moves to the Gulf of Mexico gathering strength into a
Category 3. New Orleans declares state of emergency with evacuation.
Medical: All patients discharged who can go, Shelters set up, Baton Rouge Pete
Maravich Center made into shelter

Katrina Timeline – 28 August
8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Katrina grows into a Category 5 – New Orleans issued mandatory evacuation. 10

shelters are set up

8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Katrina- Category 4 hits Louisiana President Bush makes emergency disaster

declarations
Medical: No change, levees breakdown had not impacted health care

8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Two levees break in New Orleans – people began to escape
Medical: New Orleans Hospitals begin to flood, 72 hour backup power starts
La EOC– debate about what will happen to the levees and its impact on medical, “Strike
Team” from UTSW arrives to augment EOC/MOC

8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Announcement – death toll in hundreds maybe thousands

Medical: New Orleans Hospital begin to transfer to airport for evacuation, flooding
worsens
La EOC– options weighed if full evacuation of New Orleans needed

Geography
Baton Rouge
is only land
transportation
option!

Katrina Timeline – 1 September
8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Thousands of people without food and water – hospitals plead for help
Medical: New Orleans Hospitals continue transfer to airport and out of town, flooding
worsening, USAF EMEDS arrives, National Guard begins air evacuation of patients and
evacuees.
La EOC—it is clear levees will not be repaired, full medical evac of New Orleans must
occur, “Surge Hospitals” decided upon and orders given to begin
8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
President Bush tours – “relief efforts are unacceptable”
Medical: New Orleans Hospitals flooded and out of fuel for emergency power,
thousands of pts at airport, NG continues evacuation to surrounding states
La EOC– “Surge Hospitals” building– K-Mart 1000 beds, PMac 800 beds, Field House
250 beds, Earl K. Long surge in place by 200 beds—total 2250 extra beds—
”Sufficiency of Care”
Geography
Baton Rouge
is only land
transportation
option!

8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Additional soldiers, marines and National Guard arrive
Medical: New Orleans airport—1500 litter pts in squalid conditions, “Strike Team” sent
by LaEOC to clean it out, USAF AE arrives,--2,600 pts and evacuees moved out by air
and ground
LaEOC/Baton Rouge- “Surge Hospitals” receive waves of hospital pts and evacuees by
bus, PMAC-filled up and 17 vent pts, Field House- special needs, K-Mart-hundreds of pts
and evacuees, Earl K. Long filled up
8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Superdome emptied, paramedics begin removing dead, Governor Blanco declares a
state of public health emergency
Medical: New Orleans airport empty of pts, “Strike Team” comes back to LaEOC,
AF/EMEDS up and running, USA/FST up and running on airport
LaEOC/Baton Rouge– “Surge Hospitals” running full speed, PMAC triaging into state
and surrounding states

8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Some are allowed to returned for a short period

Medical: New Orleans– some people remain, NG and USA restore order, multiple
shoot outs occur
LaEOC/Baton Rouge- demand begins to subside, expecting second peak of patients

8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
New Orleans pumping begins, investigations into Federal response
Medical: New Orleans– two hospitals reopen, order restored
LaEOC/Baton Rouge– begin to close sufficient care “Surge Hospitals”, demand
abates

8/23 8/24 8/25 8/26 8/27 8/28 8/29 8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7
Medical: New Orleans- more hospitals reopen

LaEOC/Baton Rouge– K-Mart transfers all pts to other facilities, PMAC and Field
House slow
Full Federal Response arrives and begins to be effective

Geography
Baton Rouge
is only land
transportation
option!

Tabletops
2004 – levee breached and New Orleans

flooded how to handle
August 2005 – New Orleans levee
breached on Mississippi side and New
Orleans flooded, all health care facilities
are lost!
BATON ROUGE YOU ARE UP!

None of us
Want to Face
What Lies
Ahead of Us
We Must!

A Possible Future

Federal
Units of QRP
Medical
Capability
Emergency Room
Day ICU Beds
Time
A Possible Future

Disaster
Occurs!
Federal
Units of QRP
Medical
Capability
Emergency Room
Day ICU Beds
Time
Surge Hospital/ Facility
Definition—
A facility that can be used to provide
sufficient medical care when a primary
medical facility is:
-destroyed
-contaminated and thus denied
-overwhelmed

SURGE
TRATEGIC
HARED
TILIZATION OF
ESOURSES FOR
EOGRAPHICAL
MERGENCIES
“SURGE” CONCEPTS

Definition—
-destroyed
-overwhelmed

Hospital Requirements
•Space
•Ingenuity
Nice to have
•AC
•Power
•Gases
•Back up power
Worst Nightmare
Lose whole local

health care
network!
Katrina
Tabletops
2004 – levee breached and New Orleans

flooded how to handle
August 2005 – New Orleans levee
breached on Mississippi side and New
Orleans flooded, all health care facilities
are lost!
BATON ROUGE YOU ARE UP!

Baton Rouge Area
Kmart
LSU
EOC


Definition—
-destroyed
-overwhelmed

Fall 2004 College of Architecture Project
College of
Arch fall of Who would
2004 class build a
project – hospital in a
“surge”
sports
hospitals
facility?
What is WHOEVER
heresy one NEEDS TO!
year is
reality the
next year!

College of
2004 class build a
“surge”
sports
hospitals
facility?
What is WHOEVER
year is
reality the
next year!

College of
2004 class build a
“surge”
sports
hospitals
facility?
What is WHOEVER
year is
reality the
next year!

College of
2004 class build a
“surge”
sports
hospitals
facility?
What is WHOEVER
year is
reality the
next year!

Triage
categories
are labeled
This is
exactly what
happened in
the Pete
Maravich
Center

Baton Rouge Area
Kmart
LSU
EOC

LSU Campus
Maravich Coliseum Field House

Maravich Coliseum


Standard of Care/Sufficiency of Care
Move out of circle

Sophisticated
care done in
as needed
hospitals
Move back
Less sophisticated
care done in
as quickly
“surge hospitals” Standard as possible
of Care

Move out of circle

Sophisticated
care done in
as needed
hospitals
Move back
Less sophisticated
care done in
as quickly
of Care

of Care
Care Standards
GOLD STANDARD
???
Demand
MORAL IMPERATIVE

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Red to
Registration Yellow level
patients
Entrance
Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Maravich Coliseum
Pharmacy Lab
SIC U
MIC U
Dialysis
Surgical
Wards
Ward
Peds Isolation
Registration
Entrance
Red to
Yellow level
patients

Baton Rouge Area
Kmart
LSU
EOC


Field House (Special Needs)
Peds Med I
Surgical
Med II
Entrance
Yellow to Green Level Patients


Move out of circle

Sophisticated
care done in
as needed
hospitals
Move back
Less sophisticated
care done in
as quickly
of Care

Move out of circle

Sophisticated
care done in
as needed
hospitals
Move back
Less sophisticated
care done in
as quickly
of Care

of Care
Care Standards
GOLD STANDARD
???
Demand
MORAL IMPERATIVE

Peds Med I
Surgical
Med II
Entrance
Yellow to Green Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Peds Med I
Surgical
Med II
Entrance
Yellow to Green
Level Patients

Baton Rouge Area
Kmart
LSU
EOC


Move out of circle

Sophisticated
care done in
as needed
hospitals
Move back
Less sophisticated
care done in
as quickly
of Care

Move out of circle

Sophisticated
care done in
as needed
hospitals
Move back
Less sophisticated
care done in
as quickly
of Care

of Care
Care Standards
GOLD STANDARD
???
Demand
MORAL IMPERATIVE

Empty Building (formerly Kmart)
•No Power
•No AC
•Filthy
104,992 sq. ft.

Vacant Building Set Up
Truck loading
Storage area
DECON
Bath Pediatric Acute
Pediatrics Med II Med I ICU
rooms Play area Care
Discharge
Patient/
Nursing family Dialysis
Registration
sleeping
supplies Ov
erf
Ar low
Dining ea
Donated Mental
Pharmacy
Area Health
clothing
Portable generators & ac Entry Control Point Toilets

Truck loading
Storage
Pediatric Acute
Bat Med II Med I ICU
area
Pediatrics
DECON
Play area Care
h
roo
Discharge
ms
Patient/
Nursing family Dialysis Registration
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
Area Donated Pharmacy
clothing Health
Portable generators & ac Toilets
Entry Control Point

Truck loading
Storage
Pediatric Acute
area
Pediatrics
DECON
Play area Care
h
roo
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
Pediatric Acute
Play area
area
Pediatrics
Care
DECON
h
roo
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
Pediatric Acute
area
Pediatrics
DECON
Play area Care
h
roo
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
Pediatric Acute
area
Pediatrics
DECON
Play area Care
h
roo
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
Pediatric Acute
Play area
area
Pediatrics
Care
DECON
h
roo
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
Pediatric Acute
area
Pediatrics
DECON
Play area Care
h
roo
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
Pediatric Acute
h
Play area
area
Pediatrics
Care
DECON
roo
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
DECON
Storage
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
DECON
Storage
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
DECON
Storage
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
DECON
Storage
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
DECON
Storage
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
DECON
Storage
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
DECON
Storage
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
DECON
Storage
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
DECON
Storage
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
DECON
Storage
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
DECON
Storage
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
DECON
Storage
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
DECON
Storage
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Truck loading
Storage
DECON
Pediatric Acute
h
roo
Play area
area
Pediatrics
Care
Discharge
ms
Patient/
Ov sleeping
supplies erf
low
Ar
ea
Dining Mental
clothing Health
Entry Control Point

Good
2. Surge
6. Attitude
8. Member of National Disaster Life Support (NDLS)
consortium – so well educated

Waiver of Licensure
Early on waiver of licensure requirements for the

State of Louisiana enabled volunteers to roll in
and help!
One person found who stated he was a Doctor

that was not and the nurses working with him
quickly identified him as a fraud!
This enabled volunteers from neighboring states

to go to work quickly in the health care field!

Good
2. Surge
6. Attitude

Surge Capacity
• When it became obvious that Baton Rouge was the

only viable choice for the numbers of patients
coming out of New Orleans the Surge Capacity plan
was implemented!
• This included surge in place (for hospitals), surge
into non-traditional but frequently used facilities
(sports areas), and into large empty buildings (K-
Mart)!
• This created 2250 beds of capacity.
• Two months prior a surge hospital had been bought
and was present to equip these facilities.

Good
2. Surge
6. Attitude

Regional and National Plan
• Logical build from local, to regional, to

national could not occur because the
entire local response was lost!
• An immediate decision was made to go
to the regional and national plan and it
was implemented!
• 14,000 hospital patients were moved
safely to regional and national assets
using all available resources!
Good
2. Surge
6. Attitude

Thinking About this for the Long Term
• This plan could not have come about

without the intellectual exercise of
coming up with solutions over years!
• The plan was then executed so that
many lives were saved!
• This thinking is the direct result of the
Disaster Life Support Consortium
teaching programs!

Good
2. Surge
6. Attitude

Table Top Exercises
• The series of table top exercises that

were conducted over the previous
several years make top level decision
makers intellectually address this
possibility! They had to come up with a
plan to cover this and they did it well!

Good
2. Surge
6. Attitude

Attitude
• The “can do” attitude shown by all the key

players made this whole disaster medical
response capable of being accomplished!
• The K-mart, Basketball Arena, Field House,
and Earl K. Long Hospital volunteers all
approached this as “we will do whatever is
necessary to save out patients lives!”
• AND THEY DID!

Good
2. Surge
6. Attitude

Strike Team Movement
• One of the keys to this successful response

was the alert movement of key individuals
into the Dept of Health for Louisiana on day
#1!
• This enabled the State Health Officer to keep
his head above water in dealing with the
many phone calls coming in and provided
him with a staff to work different issues that
he should not have been working on his
own!
Good
2. Surge
6. Attitude

Disaster Life Support
• Having Louisiana State University be a

charter member of the National Disaster Life
Support Consortium was a critical factor in
the outcomes discussed!
• The State of Louisiana had bought into this
educational effort from the start, had
attended the courses, and believed in what
the courses taught!
• They then executed the disaster plan with a
rapidly changing scenario!

Bad
1. Communication
2. Transportation
3. Deaths
4. Complacency to sit through the storm
5. Lack of execution of evacuation plan

Communication
• Communication is always difficult in a

dynamic scenario
• Loss of a communications
infrastructure compounded the issues.
• We must do a better job!

Bad
1. Communication
2. Transportation
3. Deaths

Transportation
• The loss of key access ports into New Orleans-
airport, bridges, railways, roads- compounded the
problem
• Lack of communication compounded this already
short resource
• The airport became the problem medically because
all patients were transported there
• This was compounded by the confusion of the
mission– an alternative treatment facility or a trans-
shipment point!
• The Strike Team from Dept of Health on Saturday
cleared us of this confusion!
• The USAF AE assets made the movement possible!

Bad
1. Communication
2. Transportation
3. Deaths

Deaths
• There were deaths in some of the

sickest patients that occurred.
• Most of these were on ventilators!
• A further analysis will be required to
find out if these were preventable or
not!

Bad
1. Communication
2. Transportation
3. Deaths

Complacency
• This is the classic “sky is falling”

discussion!
• Most of those who chose to ride out the
storm had been through worse before!
• Failure to implement a full mandatory
evacuation of the city will be discussed
for a long time!

Bad
1. Communication
2. Transportation
3. Deaths

Failure to Execute the Plan
• I believe this must be related to the

complacency discussion!
• Phone calls from the Director the
National Weather Service and the
President did not succeed in getting
this done!
• It will be discussed for a long time!

Ugly
1. Lawlessness
2. Chaos
3. Looting
4. Media

Break down of law and order
• Very concerning for our society but not

for our discussion here!

Ugly
1.Lawlessness
2.Chaos
3.Looting
4.Media

Media
• Handling the media is a very difficult

job for all concerned!
• The balance of need to know, patient
privacy, and public information is very
difficult one!
• HIPAA may be impossible to comply
with
• Dedicated MOC media person is vital to
insure that all sides are shown!
Lessons Learned
1. Start training
2. Volunteerism
3. Tabletops
4. Shorten “mother may I loop”
5. Senior mentors/strike force
6. Medical mosaic
7. Graceful degradation of care
8. Buildings of opportunities/surge hospital
9. Validate DLS family of courses
10. Communications must be fixed
11. Security is critical
Lessons Learned
1. Start training
2. Volunteerism
3. Tabletops
6. Medical mosaic
Training
• Full menu of courses must be available

to train on these scenarios
• Available today include the Disaster
Life Support Family of Courses
• Their importance was demonstrated
clearly here in this disaster!

Product of:
•University of Georgia
•Louisiana State University
•University of Texas Southwest
•University of Texas – Scott Lillibridge

Education & Training
“Cardiac Life Support”
Education
In Hospital
Care
Mo
ed
re
ACLS
nc
Sp
va
Ad
ec
Pre-hospital life
ia
re
liz
support
Mo
ed
Training
CPR
Advanced “Trauma Life Support” ATLS
Education
In Hospital
Care
Mo
ed
re
ATLS
nc
Sp
va
Ad
ec
ia
re
PHTLS
liz
Mo
ed
Training
First Aid
Courses
Education
Instructor
Mo
ed
Advanced
re
nc
va
Sp
Basic
Ad
ec
ia
re
liz
Core
Mo
ed
Introduction
Training

Education Our job is to fill in the Our job – fill in the
Educational pyramid! blanks for this menu
?
400
?
ed
Mo
Advanced
300
?
nc
Disaster Life
re
va
Support
Sp
Course
Ad
ec
Basic
re
Disaster
ia
200 ? ? ?
Mo
Life
liz
Support
ed
Course
Core
Complex
100 Disaster PHLS CPR Disasters
Life
Training

“Disaster Life Support”
First
Aero
vac Preparer
Critic
a In f
ectio
First Di s e
ases
us
Receiver FR FP FCC
•Hosp Focused •DLS Response to Hospital
Response to Bio • ATLS Radiological DLS
Educationand Toxins • ACLS Terrorism
• Forensic Science • ABLS
Mo
and Int’l Law
FRd • APLS
Advanced SNS
ed
Disaster Life
re
Training
nc
Support Program for
First
Sp
va Course Clinicians
Responder
ec
Ad
Basic
Who will review?
ia
Disaster Mayo
re
liz
Life
DIMO course
FDM
Mo
Who will certify? Support
ed
Course
Who will teach? Core
Disaster Life Harvard
What is the reward? Support
CERT
Course
Hopkins
Course
Course
Training
A – Advanced Life Support – 2 day

First Receivers
B – Basic Life Support – 8 hours
First Responders
C – Core – 4 hours
Community/First Preparers
D – Intro – hour
Community awareness
AMA meeting – December 2003 – 1st full course
“New Product – modeled after ACLS/ATLS”

None of us
Want to Face
What Lies
Ahead of Us
We Must!

12 Sept 2005
Train and Better

Prepare Our Elected
Leadership

Military Warfighter
30 Years To Accomplish
We do not have 30 years
Air for civilian warfighters –
Warcollege/ WE MUST
National CINC
War College ACCELERATE!
Air Command Commander
School College
Squadron Officer Group Wing JTF

Commander’s Commander’s Courses
School Course Course
Aerospace Basic On Scene Commander’s

Course Course
Military Warfighter
30 Years To Accomplish
We do not have 30 years
Air for civilian warfighters –
Warcollege/
National
War College
Progressive
WE MUST
ACCELERATE!
CINC
Air CommandSequential Commander

School College
Education
Squadron Officer Group Wing JTF
Commander’s Commander’s Courses
School Course Course
Aerospace Basic On Scene Commander’s

Course Course
Elected Public Officials
ANALOGY Military Warfighters
1/2 day education

County Judges plus tabletop training
Governors
Mayors
/CINC
Council of
Governments 2 day education
Intermediate plus tabletop
Warfighter Course training
City Council
School Board Basic Warfighter 2 day course BDLS

Course
Elected Public Officials
ANALOGY Military Warfighters
1/2 day education

County Judges
Progressive
Governors
plus tabletop training
Mayors
/CINC
Council of Sequential
Governments 2 day education
Education
Intermediate
Warfighter Course
plus tabletop
training
City Council
School Board Basic Warfighter 2 day course BDLS

Course
SOLUTIONS

7. Triage Screening
Hospital
11. VA Proposal
7 April 05
31 August 2005
“Menu” Brief
“RECIPE”

Cost
Calories
Taste

Courses
MENU
100 Level 200 Level 300 Level
BDLS – ADLS –
Basic Disaster Life Support Critical Infectious Diseases
Advanced Disaster Life Support
BCLS – ACLS –
Early Intervention
Basic Cardiac Life Support
Advanced Cardiac Life Support
BPLS –
ABLS – Eye Trauma Management
Basic Pediatric Life Support
Advanced Burn Life Support
BBLS –
PALS – Pararescue & Critical Care
Basic Burn Life Support
Advanced Pediatric Life Support
BHTLS – Hospital Focused Response to Bio a
ATLS –
Basic Hospital Trauma Life Toxins
Support Advanced Trauma Life Support
Forensic Science and International
DLS - Aerovac – Law
Disaster Life Support St. Louis University Courses
Office of Homeland Security C-CAT

Courses
MENU
100 Level 200 Level 300 Level
BDLS – ADLS –
Basic Disaster Life Support Critical Infectious Diseases
Advanced Disaster Life Support
BCLS –
Basic Cardiac Life Support
COST
ACLS –
Advanced Cardiac Life Support
Early Intervention
BPLS –
ABLS – Eye Trauma Management
Basic Pediatric Life Support
BBLS –
CAPABILITIES
Advanced Burn Life Support
PALS – Pararescue & Critical Care

Basic Burn Life Support
BHTLS – PROGRESS
Advanced Pediatric Life Support
ATLS –
Hospital Focused Response to Bio a
Basic Hospital Trauma Life Toxins
Support Advanced Trauma Life Support
Forensic Science and International
DLS - Aerovac – Law
Disaster Life Support St. Louis University Courses
Office of Homeland Security C-CAT

Preparation for the Nation
Making the Pieces Fit
First Preparers
First Receivers Aero General Population
vac
Critic City Planners
Hospitals al Inf
e c t io
Dise us Disaster Planners
ases
Academic Health Units National Planners
FP
Clinics FR
Health Facilities
•Hosp Focused •DLS
Response to Bio • ATLS First Responders
and Toxins • ACLS
• Forensic Science Police
• ABLS
and Int’l Law
FRd • APLS Fire
EMS
City and County Health Officials

Preparedness
2003 Brazos County
Requirement:
•Mandatory BDLS course
•All three category courses – 6 points each
•200 minimum trained
•State requirement met -- next year money comes
To qualify for State money next year Cost # Trained
• Mandatory BDLS Course 2 pts $ 5,000
• First Preparer 7 pts 3 Courses $10,000
• First Responder 6 pts 3 Courses $14,000
• First Receiver 8 pts 2 Courses $10,000
23 points $39,000 262
Minimum required by TDH 22 points On Target

Therefore : ’04 Money earned from TDH On Budget
On Trained
Preparedness
•Becomes contract for how money is

spent in advance
•Next year’s money depending on
successful completion

SOLUTIONS

7. Triage Screening
Hospital
11. VA Proposal
7 April 05
12 Sept 2005
Medical Student
Education

Future
•AAMC was visionary in requiring this
course for medical students
•I believe the Schools of Nursing,

Veterinary Medicine, and Public Health
will follow and require such educational
offerings

Update
• 2007 Class2nd MSII course given

to include tabletops
•2006 Class MS III inserted smaller
pieces throughout 3rd year

Lessons Learned
1. Start training
2. Volunteerism
3. Tabletops
6. Medical mosaic
Volunteerism
• We must have a means to identify and
categorize our volunteer groups
• These can be done in teams or by individuals
• They must be properly educated and trained
• If not done before hand, we must have just in
time training on site
• We should have a computer program of
needs and availabilities established to the
state EOC so these wonderful people can be
properly utilized
Contingency Credentialing Process
For Public
Wallet Card - Volunteer
Income tax credit for doing this!

Hospital Staff
Wallet Card - Nurse

For Providers
Wallet Card - Physician

Wallet Cards Exist Today
Texas
DSHS
Working
today

Texas DSHS
Working today

Texas DSHS
Working today

Lessons Learned
1. Start training
2. Volunteerism
3. Tabletops
6. Medical mosaic
Continuous Education Program
Table top -
Core Conventional
Disaster
Life Leadership
Support Program and
Disaster
Management Basic
Disaster
NERRTC Life
Support
2
Table top - Table top –
Biological
year Radiological/
Texas Training Initiative for

plan Nuclear
Emergency Response Advanced

T-TIER Disaster
Life
Statewide Support
Triage
SACCO
training Ventilator
Table top - Training
Chemical
Table Tops
• This mental exercise enabled several of

the key individuals to rapidly move into
a “Plan B” mode of action!
• They had run this scenario the week
prior to the real event!
• They knew their moves and executed
their thoughts!

Lessons Learned
1. Start training
2. Volunteerism
3. Tabletops
6. Medical mosaic
Civil Support
Getting There Matters…
As it stands now…
DoD/Federal response
does not get
there quickly!
When we do…
We bring a lot of
unique capabilities to
the fight!
“Mother May I Loop”
• This “in turn” permission loop is too long!

• We must have some units capable and ready
to “LAUNCH ON PROBABILITY”!
• All first response is local but help must be
identified and available on a regional basis in
a matter of hours
• Federal response must be able to arrive
quickly!
• The FOG OF WAR APPLIED HERE!
Lessons Learned
1. Start training
2. Volunteerism
3. Tabletops
6. Medical mosaic
Senior Mentors/Strike Team
• Senior mentor program should be

established to advise the EOC/MOC for
the Commissioner of Health in the state
affected
• These would be experienced people in
the field of Disaster Response
• These could be instructors in the DLS
family of courses
• Must be available in hours!
Medical Operations Center
Strike team all experienced,

fully trained, and ready
6-8 people in Commissioner to role in to help
each region of Health
available in
hours
ff
Re
sta
gu
m
lar
tea
St
ike
af
f
Str

Lessons Learned
1. Start training
2. Volunteerism
3. Tabletops
6. Medical mosaic
Move out of circle

Sophisticated
care done in
as needed
hospitals
Move back
Less sophisticated
care done in
as quickly
of Care

Move out of circle

Sophisticated
care done in
as needed
hospitals
Move back
Less sophisticated
care done in
as quickly
of Care

Lessons Learned
1. Start training
2. Volunteerism
3. Tabletops
6. Medical mosaic
of Care
Care Standards
GOLD STANDARD
???
Demand
MORAL IMPERATIVE

of Care
Care Standards
GOLD STANDARD

???
Demand
MORAL IMPERATIVE

Move out of circle

Sophisticated
care done in
as needed
hospitals
Move back
Less sophisticated
care done in
as quickly
of Care

Move out of circle

Sophisticated
care done in
as needed
hospitals
Move back
Less sophisticated
care done in
as quickly
of Care

Lessons Learned
1. Start training
2. Volunteerism
3. Tabletops
6. Medical mosaic
Buildings of Opportunity
• These represent the most cost effective

way of surging our medical facilities
into “sufficiency of care”
• They should be identified and prepared
• They must be stocked with medical
supplies in a short period of time
• They should complement portable
shelter systems for medical care
SURGE
TRATEGIC
HARED
TILIZATION OF
ESOURSES FOR
EOGRAPHICAL
MERGENCIES
SURGE
Build modular facility with
docking receptacle door
Have empty buildings ready to
go for a surge scenario
Use mobile vans to maintain
Standard of Care

Modular End State
Could be all vans and simple

docking receptacles for:
dialysis
lab
OR
optical
GT
Patient ward
Burn isolation
Pharmacy
Dental
Pregnancy
ICU

“OR”
Any other combination of
“bricks and mortar “ and
mobile units

Sufficiency of Care
• This would have enabled us to continue

Standard of Care with a Kmart situation
by simply docking a modular van that
meets all standards of care and is used
every day to provide rural health care.
• In a contingency you just recall it and
plug it into the docking station on your
Surge Hospital

Surge Hospitals
• Do not close them prematurely!

• Baton Rouge closed them on Wed and
started dismantling them on Wed and
Thursday only to need them on Thursday
night!
• Stop operations but keep in reserve until it
is very clear they are not needed!
• Move in and out of Standard of Care as
needed but do not deny yourself options!
Lessons Learned
1. Start training
2. Volunteerism
3. Tabletops
6. Medical mosaic
DLS Family of Courses
• I have no doubt that the mental preparation
given by this family of course enabled the
State of Louisiana to cope with this disaster
• They had addressed such a disaster in a
series of table top exercises and training
courses for over 4 years
• They had ordered equipment that was
available and used when needed as a result
of this preparation

Lessons Learned
1. Start training
2. Volunteerism
3. Tabletops
6. Medical mosaic
Communications
• This is a repeated failure item in disaster

response!
• A graded response of cheap, battery
powered, communication devices must be
readily available and the people must know
how to use them!
• The communications can be upgraded over
time by portable equipment that increases
the capability of the hand held devices!

Event Response Umbrella
Response Time
Rebuild Infrastructure > 72 hours
ECRV 12 – 36 hours
Handheld Family Radios 0 – 12 hours

Emergency Communications
Response Vehicle
Satellite RapidLink AP
Data/Voice WLAN
Comm
Canope RapidLink
Data Backhaul Mesh Network
Mobile Telescoping
Antenna Mast
Harmony
Local Voice Comm
ACU 1000T
Voice Interop
Humvee
Transport/Control/Power
The Texas A&M University
EnvironmentSystem Health Science Center
System Capabilities
• Harmony 17 talk path (3 RF Channel) system
• Secure voice enhanced range
– 5 - 7 miles
– expandable by adding linked site
• Units have rechargeable batteries
• Private call and group call
• Digital voice and packet data application support
• Interoperates with basic radios deployed on
onset of event
• Provides limited telephone calling through
satellite
Cost Estimates
ITEM No. Units Price per unit Total

900 MHz 100 750.00 $75,000.00
Battery Charger Bank 10 500.00 $5,000.00
Storage Packing 5 500.00 $2,500.00
Consumable Spare Radios 10 500.00 $5,000.00
Miscellaneous Accessories 1 5,000.00 $5,000.00
Harmony Repeater 1 200,000.00 $200,000.00
Interoperability Switch 1 15,000.00 $15,000.00
Antenna/trailer/Generator 1 50,000.00 $50,000.00
Satellite Link 1 45,000.00 $45,000.00
Mesh Networking Links 6 5,000.00 $30,000.00
WiFI Access Points 5 1,000.00 $5,000.00
Budgetary Estimate $402,500.00
Per Radio Price $4,025.00

Concept of Operation
• Assigned to Texas Task Force 1

• Exercised by Telecom students at A&M
• Used in Disaster City scenarios
• Deployed during emergencies

Lessons Learned
1. Start training
2. Volunteerism
3. Tabletops
6. Medical mosaic
Wristbands

Federal Response
• All the players are hard to keep up with!

• They are there to help the local and
state chain of command!
• They are not there to take over or
interfere!
• They have a military mindset in terms
of command and control, mission,
structure, etc.
Typical Daily Briefing
• These are called Situation Reports– “sit

reps”
• Issued daily for all to see
• The Louisiana MOC never saw these!
• A good example of poor
communication!
• The federal response never got the
Louisiana MOC updates on bed
availability, etc,
Hurricane Katrina Medical Response Update
Part I (Louisiana)
1100 EDT September 9, 2005

New Orleans Civilian Hospital Status
Kenner
Regional Medical
• New Orleans Civilian
Center
Hospital Status Gentilly
– Three local hospitals East
•Tulane Jefferson
accepting patients University Hospital Meadowcrest
of varying degree Medical
Hospital
Center
– JTF Katrina Medical Complex (3
Teams assisting facilities)
with assessments •LSU
• Interagency patient Medical
accountability Center Kindred
•Medical Hospital
– Medical facilities
Center of
reporting patient LA West
locations Jefferson
Oschner Memorial Hospital
Weime
Sisters of Medical
Maria
Charity Center
3 Civilian Office
Hospitals Accepting
of Homeland Security Patients
LA State Regional Medical Support
Shreveport Region 7
285 Acute Adult Monroe Region 8
40 ICU Adult 228 Acute Adult
29 Acute Ped 34 ICU Adult
15 ICU Ped 43 Acute Ped
68 Psy 23 ICU Ped
12 Psy
Baton Rouge Region 2

30 Acute Adult
Alexandria Region 6 6 ICU Adult
164 Acute Adult 19 Acute Ped
13 ICU Adult 3 ICU Ped
17 Acute Ped
1 ICU Ped
2 Psy
Lafayette Region 4
124 Acute Adult Covington Region 9
16 ICU None Reported
19 Acute Ped
4 ICU Ped
New Orleans Region 1

None Reported but three
facilities are open
Lake Charles Region 5

Thibodaux/Houma Region 3
145 Acute Adult
76 Acute Adult
22 ICU
7 ICU Adult
4 Acute Ped
0 Acute Ped
2 ICU Ped
0 Psy
Office of Homeland Security 0 ICU Ped

NDMS Medical Support
Current 1000L 08 Aug 05
Bogalusa Washington
Parish
MO-1, OH-6, IA-1
Zephyr Field
New Orleans Airport
OH-6
TX-4, WA-1, OR-2,, AL-3,
PA-3, TX-1, AK-1, CA-3 Kindred Hospital
CA-11
Covington High
School
OH-1 West Jefferson Parish
NY-2
Lamar Dixon Shelter

Ochsner Hospital
Gonzales LA
TN-1
VMAT 5, VMAT 1
Chalmette Refinery–
St Gabriel
St Bernard Parish
DPMU W, DMORT 6/7/8,
AZ-1, VMAT Serv
DMORT WMD, FAC, CA-6
Plaquemines Parish
Thibodaux – Nichols State
East Jefferson Parish HI-1
University
RI
OK-1, TX-3
POC: JRMPO LA JFO
The Texas A&M University System Health Science Center NDMS
CDC Support
New Orleans
ATSDR (6)
Baton Rouge COTPER (1)
ATSDR (2) EPA (2)
BPRP (1) ITSO (1)
COTPER (2 NCBDDD (1)
NCCDPHP (1) NCEH (3)
NCEH (2) NCHM (2)
NCHS (1) NCHSTP (1)
NCHSTP (1) NCID (7)
NCID (3) NCIPC (2)
Alexandria/Ft Polk NIOSH (2)
SNS (2) NCPHI (1)
NIOSH (1) NIP (3)
NCBDDD (1) OD (2)
OWCD (1) NIP (4)
Non-CDC (2) OGDP (1)
OD (1) OWCD (1)
SNS (10) Non-listed (8)

POC: JRMPO LA JFO
The Texas A&M University System Health Science Center NDMS
Military Medical Support
TBD
Co E(-) 735th MSB
Co C(-) 328th FSB USS COMFORT 14 CSH
TBD ADVON Only
Mission TBD TBD
ALEXANDRIA AIR PARK

FMCS 250 beds Pckg Hammond, LA
DIV Surgeon Cell/DMOC Belle Chase NAS
MED LOG CO ANG/EMEDS+25
Co C(-) 634thFSB New Orleans
498th MED (-) 148th BAS
149 MDG 498th MED (-)
812 MED (-) (MEDEVAC)
SJTFHQ-N
MSY/NEW ORLEANS IAP

Baton Rouge JFO USAF/EMEDS+25
JRMPO (3) USAF/CASF+25
SJFHQ
Carville, LA
Level I&II Clinic USS IWO JIMA
ARNG CST 75 hospital beds USS BATAAN
15 ICU beds 75 hospital beds
JTF-K-W 15 ICU beds
POC:
The Texas A&M University System Health Science JRMPO LA JFO
Center
ESF-8 Public Health & Medical Services (Health &
Human Services) DMAT Locations/Missions
FEMA - FEMA deployed over 61 National Disaster Medical

System Teams and 28 urban search and rescue teams with 7,000
personnel to save lives and render medical assistance. Teams
have rescued more than 350 hurricane victims. Teams Engaged:
64 [(-) behind a DMAT name indicates less-than 35 person roster]
Biloxi High School, Biloxi, MS: CA-1 DMAT
Biloxi Regional Medical Center, Biloxi, MS: OH-5 DMAT; MA-1
Strike Team
Crosby Memorial, Picayune, MS: FL-5 DMAT
Garden Park Hospital / Gulfport, MS: MI-1 DMAT; KY-1 Strike Team
Gulfport Memorial Hospital, Gulfport, MS: NC-1 DMAT
Hancock Elementary School, Bay St. Louis, MS: FL-6 DMAT
Hancock Medical Center, Bay St. Louis, MS: MO-1 DMAT; FL-1
DMAT; PA-1 & IA-1C Strike Teams O.S. Convention Center, Ocean
Springs, MS: FL-4 DMAT, MN-1 Strike Team
ESF-8 Public Health & Medical Services (Health &
Human Services) DMAT Locations/Missions
Gulfport-Biloxi Municipal Airport, MS: DPMU-E, DMORT 1, 2, 4 & 5;

DMORT-FAC/E
Fairgrounds, Jackson, MS: VMAT-3
Keesler, MS: VMAT-2; NMRT-East
Keesler Air Force Base, Biloxi, MS: MA-1; IA-1B & VA-1 Strike Team
Alpha
Noble Training Center, Ft. McClellan, AL: IL-2 MHAT, IA-1A Strike
Team
Home Staged, Alerted: NY-2B DMAT; IMSURT-S
New Orleans Airport, New Orleans, LA: TX-4, CA-4, WA-1, FL-3, OR-2,
MA-2, AL-3, CA-6, PA-3 DMAT; AR-1, TN-1, AK-1, HI-D; GA-4 Strike
Team
New Orleans Ice Rink, New Orleans, LA: RI-1 DMAT
Nicholls State University Thibodaux, LA: OK-1 DMAT & TX-3 Strike
Team
ESF-8 Public Health & Medical Services (Health & Human
Services) DMAT Locations/Missions
LSU Arena, Baton Rouge, LA: NM-1 DMAT

Covington High School Shelter, Covington, LA: OH-1 DMAT
St. Gabrielle, LA: DPMU-W, DMORT 6, 7 & 8; DMORT-FAC/W; DMORT-WMD,
CA-6 Strike Team
Louisiana State Veterinarian School, Baton Rouge, LA: VMAT-1, VMAT-5
Astrodome, Houston, TX: CO-2/NMRTC
Kelly Air Station, San Antonio TX: TX-1 DMAT & FL-2 DMAT
Ford Pavilion, Beaumont, TX: CA-2 DMAT
Reunion Arena, Dallas, TX: GA-3 DMAT
Teams Staged: 9
LSU, Baton Rouge, LA: AR-1; MN-1; NY-2; OH-6 DMAT; PA-2 Strike Team;
SC-1(-); MO-1(-); TN-1(-) DMAT; CA-3 Mental Health
Home Staged, Alerted: CA-9; NMRT-W DMAT; IMSURT-W
En Route to Baton Rouge: 7
LSU, Baton Rouge, LA: NY-4(-); AK-1(-); AZ-1 (-); CA-11(-); KY-1(-) DMAT;
IMSURT-E

Lots of Opportunities for Improvement
• We must take these lessons learned and vet

them through the process so that our next
disaster is run even better than this one was!
• Way ahead is to debrief the State of
Louisiana leadership, work with JCAHO to
develop more formal guidelines for “surge”,
and seek to implement these lessons learned
into local, state, and national operations
plans!

To obtain a copy of this presentation:
www.tamhsc.edu/homeland/
Questions?
Dr Paul K. Carlton, Jr.

Lt Gen, USAF, Ret
Director, Homeland Security

New Orleans

New Orleans

New Orleans

New Orleans

New Orleans

New Orleans

New Orleans

New Orleans

New Orleans

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

Airport

EOC

EOC

EOC

EOC

EOC

EOC

EOC

EOC

EOC

EOC

EOC

EOC

EOC

EOC

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EOC


Threats That Face Our Nation and Viable Solutions - Medical Perspective

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Threats That Face Our Nation

and Viable Solutions -

Office of Homeland Security

Lose whole local

Three deadly misconceptions:

Office of Homeland Security

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“Every revolutionary idea evokes

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All of these have some part of the

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It all comes to life

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IT’S ALL ABOUT PEOPLE

“We could see collapse of our

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Chuck Ludlam, Chief of Staff

“Medicine is our weak link

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Different worlds – they do not understand each other

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Different worlds – they do not understand each other

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• Delivery of acute medical care evolved beyond ordinary business

Dara, Ashton Farmer, Feb 05

• Possible “surge” solutions

Dara, Ashton Farmer, Feb 05

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“It’s an unsustainable situation. Without

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These are the facts!

Senator Daniel Patrick Moynihan, NY

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Local Infrastructure Baseline Aeromedical

Local Infrastructure Baseline Aeromedical

Requires “Tools in the Toolbox”

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Public Health Course

Eye Trauma Course

Critical Infectious Diseases Course

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12:15 pm – Explosion in dining facility

12:25 pm Triage begins

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• Attack by suicide bomber on food tent in Forward Operating Base

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“Standard of 7 Open laparotomies

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• Triage needs work