Hurricane Katrina: Laboratory Preparedness Redefined - Clinical … · 2016. 5. 17. · Hurricane Katrina – Clinical Lab Perspective – During/Post Storm Continuity of Operations

Association of Public Health LaboratoriesAssociation of Public Health Laboratories2006 Annual Meeting2006 Annual Meeting

Hurricane Katrina: Laboratory Hurricane Katrina: Laboratory Preparedness Redefined Preparedness Redefined -- Clinical Clinical

Lab PerspectiveLab Perspective

Fred H. Rodriguez, Jr. M.D.Fred H. Rodriguez, Jr. M.D.Director, Pathology and Lab Medicine ServiceDirector, Pathology and Lab Medicine Service

VA Medical Center, New Orleans, LAVA Medical Center, New Orleans, LAEmma S. Moss Professor of PathologyEmma S. Moss Professor of Pathology

LSU School of Medicine, New Orleans, LALSU School of Medicine, New Orleans, LA

Hurricane Katrina Hurricane Katrina –– Clinical Lab Clinical Lab PerspectivePerspective

Focus of clinical labs is patient careFocus of clinical labs is patient careDifferent scope and mission (role) from Different scope and mission (role) from public health, environmental, commercial public health, environmental, commercial reference labsreference labsSimilarities of facility operationsSimilarities of facility operationsDifferences of facility operationsDifferences of facility operations

Patients on sitePatients on siteCanCan’’t plan a shutdown of lab operations if t plan a shutdown of lab operations if supporting acute patient caresupporting acute patient care

Hurricane Katrina Hurricane Katrina –– Where was Where was Fred ?Fred ?

Was present in New Orleans during hurricane Was present in New Orleans during hurricane Katrina and six days post stormKatrina and six days post stormWas a Was a ““guestguest”” of Ochsner Medical Centerof Ochsner Medical CenterAcknowledgement to Dr. Bobby Acknowledgement to Dr. Bobby RodwigRodwig for for being allowed to observe lab operations at being allowed to observe lab operations at Ochsner during and after the stormOchsner during and after the stormAcknowledgement to Dr. Tom Weilbaecher for Acknowledgement to Dr. Tom Weilbaecher for serving as the serving as the ““onon--sitesite”” Acting Director of the Acting Director of the New Orleans VA Medical Center Pathology and New Orleans VA Medical Center Pathology and Lab Med Service during and after the stormLab Med Service during and after the storm

Dr. Rusty Rodriguez at Charity Dr. Rusty Rodriguez at Charity Hospital, New OrleansHospital, New Orleans

Hurricane Katrina Hurricane Katrina –– Clinical Lab Clinical Lab Perspective Perspective –– PrePre--StormStorm

Planning is critical (continuity of operations):Planning is critical (continuity of operations):PersonnelPersonnel

•• OnOn--site teamsite team•• OffOff--site teamsite team

CommunicationsCommunicationsOperationsOperations

•• Capabilities (Capabilities (““whatwhat””))•• Capacity (Capacity (““how muchhow much””))•• Back upsBack ups•• Supplies (inventory for how long?)Supplies (inventory for how long?)

Hurricane Katrina Hurricane Katrina –– Clinical Lab Clinical Lab Perspective Perspective –– PrePre--Storm (Storm (concon’’tt))

Planning is critical (Planning is critical (concon’’tt):):Emergency utilities:Emergency utilities:

•• ElectricityElectricity (how much (how much ““loadload”” can emergency generator can emergency generator support)support)

LightsLightsInstrumentationInstrumentation

•• PhonePhone (Land lines/Cell/Satellite)(Land lines/Cell/Satellite)•• WaterWater

PotablePotableSanitary usesSanitary uses

•• Computers Computers (IT/Internet)(IT/Internet)•• HHeateatVVentilationentilationAAirirCConditioningonditioning (HVAC)(HVAC)


Hurricanes are NOT an unusual event for Hurricanes are NOT an unusual event for New OrleansNew OrleansWe review, drill, prepare every yearWe review, drill, prepare every yearFor previous 3 to 5 years we had activated For previous 3 to 5 years we had activated our facility hurricane event plan at least our facility hurricane event plan at least once each year (NOT as a drill)once each year (NOT as a drill)We thought we were experienced, ready, We thought we were experienced, ready, and preparedand prepared



Activated Activated ““call backcall back”” plan for the plan for the ““onon--sitesite”” team team Saturday middaySaturday middayStaff told (per plan) to report to duty Sunday AM Staff told (per plan) to report to duty Sunday AM with 3 to 5 days of personal effectswith 3 to 5 days of personal effectsRoles, responsibilities, communications Roles, responsibilities, communications reviewedreviewedStaff completed their personal preparations Staff completed their personal preparations (secured home/evacuated family)(secured home/evacuated family)““OffOff--sitesite”” staff advised to evacuate citystaff advised to evacuate cityEvery member of the Every member of the ““onon--sitesite”” team reported for team reported for dutyduty

Hurricane Katrina Hurricane Katrina –– Clinical Lab Clinical Lab Perspective Perspective –– During/Post StormDuring/Post Storm

Continuity of OperationsContinuity of OperationsSeverity of facility damage, status of communications, Severity of facility damage, status of communications, staffing, operational status of equipment, etc. determine staffing, operational status of equipment, etc. determine level of functional status (what/how much works)level of functional status (what/how much works)If spared, can assume role to assist other community If spared, can assume role to assist other community facilities with greater infrastructure damage per facilities with greater infrastructure damage per interoperability agreementsinteroperability agreements–– accept referrals until accept referrals until capacity exceededcapacity exceededReturn to Return to ““normalnormal”” activity?activity?Facility security a key function to be maintainedFacility security a key function to be maintainedProviding assistance depends on interProviding assistance depends on inter--facility transport facility transport and uninterrupted communicationsand uninterrupted communications

Hurricane Katrina Hurricane Katrina –– Clinical Lab Clinical Lab Perspective Perspective –– During/Post StormDuring/Post StormBut, what happens when the disaster doesnBut, what happens when the disaster doesn’’t t read the read the ““planplan”” or chooses not to follow the or chooses not to follow the ““planplan””??

ALLALL forms of communication lostforms of communication lostEmergency utilities severely limited (or gone Emergency utilities severely limited (or gone completely)completely)Staff cannot contact familyStaff cannot contact familyUncertainty of relief (facility isolated by flood)Uncertainty of relief (facility isolated by flood)Instrumentation (and staff) heat/humidity sensitiveInstrumentation (and staff) heat/humidity sensitiveSupplies (water, food, reagents) run shortSupplies (water, food, reagents) run shortShut down of operations (degraded operations)Shut down of operations (degraded operations)Survival modeSurvival mode

VA Medical Center, New Orleans VA Medical Center, New Orleans Post StormPost Storm




Hurricane Katrina Hurricane Katrina –– Clinical Lab Clinical Lab Perspective Perspective –– During/Post StormDuring/Post StormOnOn--site site leadershipleadership::

As the situation evolves, revise the As the situation evolves, revise the ““planplan”” (be flexible, (be flexible, ““nimblenimble””))Focus on achievable goals (reassess capabilities and Focus on achievable goals (reassess capabilities and capacity) (capacity) (““statusstatus””))Simplify objectives (focus on basic essentials)Simplify objectives (focus on basic essentials)Communicate reliable information (vertically and Communicate reliable information (vertically and horizontally) as often as it is available (horizontally) as often as it is available (““knowledgeknowledge””, , ““trusttrust””) (emotional support)) (emotional support)Define new tasks (give staff a purpose) (assist Define new tasks (give staff a purpose) (assist elsewhere in the facility)elsewhere in the facility)

Hurricane Katrina Hurricane Katrina –– Clinical Lab Clinical Lab Perspective Perspective –– During/Post StormDuring/Post Storm

Hurricane Katrina Hurricane Katrina –– Clinical Lab Clinical Lab Perspective Perspective –– During/Post StormDuring/Post StormOffOff--site leadership:site leadership:

ReRe--establish communication if at all possibleestablish communication if at all possibleDefine achievable goalsDefine achievable goalsCoordinate reliefCoordinate relief

•• PersonnelPersonnel•• SuppliesSupplies•• TransportationTransportation

Collaborate with other agencies (may be difficult)Collaborate with other agencies (may be difficult)•• Diversion of servicesDiversion of services

Coordinate extraction and evacuation of the facility if Coordinate extraction and evacuation of the facility if necessarynecessary


Lessons learned:Lessons learned:No plan can anticipate all contingenciesNo plan can anticipate all contingenciesAll plans have assumptions that may All plans have assumptions that may ““doomdoom””the planthe planBe flexible Be flexible –– constantly reassess as situation constantly reassess as situation evolvesevolvesPlan for self sufficiency for longer than you Plan for self sufficiency for longer than you thinkthinkMaintaining communication is the most Maintaining communication is the most important essentialimportant essential


““My nephew, Dr. Rusty Rodriguez, is a resident at Charity My nephew, Dr. Rusty Rodriguez, is a resident at Charity Hospital in New Orleans. He lived through experiences Hospital in New Orleans. He lived through experiences no one should have to live through. No food, no water, no one should have to live through. No food, no water, no power, people suffering, people dying. And, of no power, people suffering, people dying. And, of course, no communications. When he needed to course, no communications. When he needed to communicate with another hospital down the street, he communicate with another hospital down the street, he had to take a boat. That workedhad to take a boat. That worked——as long as the snipers as long as the snipers were taking a break. Rusty came through it all, and hewere taking a break. Rusty came through it all, and he’’s s our family heroour family hero——but I think maybe we asked too much of but I think maybe we asked too much of Rusty and of all the others who shouldered the terrible Rusty and of all the others who shouldered the terrible burden of caring for the sick in such sickening burden of caring for the sick in such sickening circumstances.circumstances.””——

Michael Michael CoppsCopps, Federal Communications Commissioner, Federal Communications Commissioner(from a September 15 FCC field hearing report)(from a September 15 FCC field hearing report)


Lessons learned (Lessons learned (concon’’tt):):Include evacuation in planning processInclude evacuation in planning processEvacuation plan must include needs of both patients Evacuation plan must include needs of both patients and staff (and staff (““whowho””):):

•• Transportation (Transportation (““howhow””) (need a resource away from the ) (need a resource away from the disaster area)disaster area)

•• Destination (Destination (““wherewhere””) (set up collaborative arrangements ) (set up collaborative arrangements prior to the disaster)prior to the disaster)

•• Disposition at destination (Disposition at destination (““whatwhat””))

““Know when to hold them, and know when to fold Know when to hold them, and know when to fold themthem”” ((““whenwhen””))

KatrinaKatrina’’s Aftermaths Aftermath



Post KatrinaPost KatrinaRecovery/RestorationRecovery/Restoration

Still a work in progress,Still a work in progress,but New Orleans is coming back!but New Orleans is coming back!

Post KatrinaPost KatrinaRecovery/RestorationRecovery/Restoration

Jackson Square Jackson Square -- JanuaryJanuary 20062006

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Hurricane Katrina: Laboratory Preparedness Redefined - Clinical … · 2016. 5. 17. · Hurricane Katrina – Clinical Lab Perspective – During/Post Storm Continuity of Operations