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Examples of the range of medications required following a disaster and evacuation was drawn from the reviewed articles, and is summarised in Table 5. Even for other patients, medical records including allergy to medications 24 , 30 , 31 , 46 , 47 are essential. For patients with specific medical devices such as pacemakers, style and serial numbers of the devices is important It is recommended that individuals keep a list of these essential items , which should be reviewed updated periodically 46 and the list preferably kept it in wallet or purse, which is likely to be brought along during an emergency Prescriptions specific to emergency situations should also be considered for each patient.

Critical Challenge: National Preparedness

For example, dialysis patients need to bring a potassium-exchanging resin, which is essential to reduce the potassium level when the access to dialysis is limited 49 , Devices for insulin injection vials, needles or pens with replaceable cartridges of insulin 31 , gluco-metres 4 , 31 , 51 , fluids and devices for peritoneal dialysis, 20 nebuliser machines, CPAP machines, oxygen cylinders, 51 batteries for aspirators and artificial ventilators 52 , suctioning and tube feedings, and canned nutritional supplements for the tube feedings 53 should also be considered as part of the emergency pack for patients to bring.

Supportive tools for daily life, such as wheel chairs, hearing aids 47 , canes, walkers, 51 dentures, glasses 43 , 47 , extra batteries for wheelchairs and other assistive devices, and incontinence briefs for the elderly 47 are often lost at the time of evacuation. For those who cannot speak, bringing a personal identifier is also critical Over-the-counter medicines, such as medication for fever or pain, anti-histamine for allergy, denture adhesive, and sanitary products are also important when access to pharmacies are disrupted For those with hand disabilities, openers for the medications are also an essential item This systematic review revealed that a considerable number of patients lose their medication during evacuation.

As a result, medication refill is an immediate health need, making the prescription of medications for pre-existing conditions an increasing burden of medical relief activities at a time when acute needs are also over-whelming. At the current time, preparedness with respect to medications for disasters is not fully appreciated nor given much attention by those requiring daily and constant medication; meaning that a large number of patients facing extreme events could have avoided prescription interruption had they not lost their medication and or medical devices.

Until individuals, with the assistance of their healthcare providers, undertake preparative actions, those organising relief activities need to be prepared to cope with emerging treatment alongside the management of chronic illnesses, including medication refills and devices.

How to evacuate a psychiatric hospital: a Hurricane Katrina success story.

The discussion is presented by a the impact of medication loss and interruption of care, b the impact of prescription refill post disaster and c the value of effective preparation actions. Studies from developed countries show that the impact of medication loss and interruption of care can be a significant issue.

From the results above, it is possible to demonstrate that surveys targeting paediatric patients in New Orleans after Hurricane Katrina revealed that In a questionnaire-based survey of geriatric patients visiting a hospital in Florida one year after Hurricane Wilma, 3. Some studies found that although some people brought their medication with them upon evacuation, they had only brought enough supply for a limited period After the Great East Japan Earthquake and the following tsunamis in , many evacuees had no time to gather their belongings.

Some of them were treated with unique medication, such as immuno-suppressants, which were not obtainable at the disaster area. As a result, these patients had to stop their medication for weeks knowing that their medical conditions would deteriorate The problem regarding medication loss is not limited to developed countries.

The Evacuation of Older People: The Case of Hurricane Katrina – Items

Some articles reported medication by specific chronic condition, which showed that the level of preparation may vary by conditions. People with mental illness are also at high risk of medication interruption 23 , 1. Examples of loss of medication lists and medical devices were identified as medical and life-support devices are as important as technological tools like haemodialysis and oxygen. A questionnaire conducted on the evacuees two weeks after Hurricane Katrina revealed that medical services were only the fourth most commonly reported medical need.

Katrina, The New Orleans Nightmare : Documentary on the Devastation of Hurricane Katrina

Other devices needed were hearing aids, canes, wheel-chairs, and walkers The high prevalence of the need of prescriptions becomes a burden on medical teams at the disaster area which was identified in Table 4. For example, an analysis of survey data after Hurricane Katrina revealed 7. Looking at the timeline of health needs following a disaster, the proportion of medication refills does not appear to change between the early and late stage of the relief activities. For example, according to a retrospective review on the patients seen by a Disaster Medical Assistance Team during four extreme events in New Mexico, US, the proportion of the patients visiting for medication refill was 6.

Even for specialty care, medication refill often shares a significant part of relief activities. After Katrina, of patients who were seen by mental health professionals, Despite medication refills being a common need among the disasters studied, the proportions of patients coming to health facilities for medication refill vary within and between events. For example Additionally, a comparison between disasters suggested the burden differs depending on the scale and types of the disasters 66 For example, Cookson et al. In other cases, the proportion requiring medication refill was reported to be 3.

Twelve articles described possible effective preparation actions for patients. Having a personal stockpile is recommended in many articles, though the recommended personal stockpile ranges from days 20 , 74 to 1 month In a survey study conducted in California, US, the proportion of those who had a 2-week supply of medication ranged from It was customary in India for pregnant women However, just keeping extra doses of medication stockpiled is likely to have limited impact.

In a hospital-based survey study targeting evacuated outpatients from the Japanese flash flood in , keeping a personal stockpile did not increase the likelihood of bringing medications to the evacuated sites On the other hand, those who had prepared an emergency pack were 5. Therefore, the researchers recommended that the stockpile is packed in a bag for easy access. Even so, the compliance for making an emergency pack seems to be low. Other researchers reported that although Carrying medications at all time 58 , 78 , 79 or keeping extra medication in multiple places, such as schools and offices 80 , are described as the most robust and effective emergency plan for patients.

However, low compliance with this action has been reported. Although having a personal stockpile is recommended by the Centres for Disease Control and Prevention CDC and the American Red Cross 81 , our review implies that just having a personal stockpile might not be effective Many onsite workers recommend patients should have an emergency bag. First of all, they should provide patients with medications and other resources sufficient for disaster preparedness as well as up-to-date medical records. Thirdly, they must help patients to design an individualised and practical emergency plan that takes in to account patient-specific barriers such as forgetfulness, 58 side effects 8 , and allergy In addition, they can help train patients in practices of safe storing medicines and packing necessary medical devices 75 : the medication and medical devices in the emergency pack should be effectively protected from contamination by toxins from flood waters 84 or mechanical damage by an earthquake Fourthly, in disasters for which there is some advance warning, such as hurricanes, health professionals may make contact with patients when a disaster alert has been made, reminding them to bring their medication and medical records when they evacuate 58 , Finally, and most importantly, front-line public health workers and the members of rescue teams should have adequate medication for their own medical conditions to sustain them for the duration of their rescue efforts during a disaster 56 , Recently, an increasing effort has been made by national and local governments in several countries to encourage patients to prepare an emergency bag.

Even so, evidence is still weak with regard to preparedness actions by patients and the efficacy of intervention to encourage preparation. Researchers should be actively involved in disaster plans to leverage the preparedness among patients. For example, health impacts caused by loss of medication should be assessed using feasible and standardised methods to enable targeted aid following a disaster.

Baseline data should also be measured and made available to appropriate agencies, including the burden of chronic diseases in each community 87 , 88 , health care disparities 89 , vulnerable populations for whom preparedness is a challenge 90 , preparedness of general or specific groups of people 34 , 37 as well as factors that affect emergency preparedness Intensive research following disasters is also critical, and should include rapid health needs assessment among the evacuees, 37 , 61 health impact assessment including medication adherence 92 , and evaluation of the efficacy of preparedness actions 90 to inform future planning and preparation.

Box 1. Summary of key findings. The most significant limitation of this study is lack of comparative data. There is no standardised way of measuring the impact of bringing medication at evacuation. Most frequently, survey is conducted on convenience samples, which makes it hard to generalise beyond that particular population. After a disaster, obtaining quality data is challenging due to the flow of evacuees and temporary nature of their status, lack of personnel, and ethical concerns accompanying the conduct of research on suffering people.


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Simple, unobtrusive and feasible approaches of monitoring preparedness and health outcomes should be carefully designed and established before disasters occur, especially in those regions subject to frequent disasters. Another limitation is publication bias; most of the relevant articles were from the US, and a large proportion specifically focused on hurricane Katrina. There is a clear need for evidence from all over the world, and from the most marginalised, thus rarely reported, populations.

This research does not focus on longer term crises, such as drought or political and economic failures, in which restoration of healthcare provision may take many months 5. Health professionals have a responsibility to educate patients about the potential health impacts of medication interruption, emphasising that bringing medication and medical records may be the only way to enable them to continue normal care in an emergency.

They must help patients to design an individualised and practical emergency plan that takes in to account patient-specific barriers such as forgetfulness. In disasters for which there is some advance warning, such as hurricanes, health professionals may make contact with patients reminding them to bring their medication and medical records when they evacuate.

Front-line public health workers and the members of rescue teams should have adequate medication for their own medical conditions to sustain them for the duration of their rescue efforts during a disaster. People may survive the initial disaster but if they are not educated or appropriately prepared in particular when medication is involved they may not survive the aftermath.

Abstract AIM: The aim of this systematic literature review was to identify the extent and implications of medication loss and the burden of prescription refill on medical relief teams following extreme weather events and other natural hazards. Funding Statement This project was not funded.

The authors have declared that no competing interests exist. Introduction After an extreme weather event or other natural hazard, the continuity of routine care is one of many challenging aspects of post disaster healthcare. Study selection The search was conducted on 5 th September, and generated 5, results of which 1, were duplicates and removed, leaving 3, records, Out of these records 2, were apparently irrelevant when screened by title exclusion criteria.

https://contimbscarah.tk Results This is the first systematic review that has addressed the topic of medication needs in disaster driven evacuation. Table 3 Table 3A Evacuees A significant proportion of evacuees from, or residents at, disaster areas lost their medication. Table 3B Patients with specific condition types In this section, the focus was on people with specific medical conditions and availability of continued medication treatment following an extreme event.

Table 3C Population based studies In this section six reports focus on groups of people and their medication treatment in the USA following Hurricanes Ivan, Katrina and Wilma and the flooding in state of Iowa. Table 4 Table 4 is a summary of articles reporting on prescription refills, by study type and lists chronologically the disaster, type of research, number of patients and the relevant outcome from each study. Table 5 Table 5. Discussion This systematic review revealed that a considerable number of patients lose their medication during evacuation.

The key findings and recommendations are summarised in Box 1. And that will most likely be shut down," Mr. Nagin said. As the hurricane, with winds of about miles per hour, headed toward the area this morning, thousands of people in New Orleans jammed freeways leaving the city, while others nailed boards over the windows of their businesses. Stranded tourists and others unable to leave are able to use the Louisiana Superdome as a shelter.

With a state of emergency declared, federal emergency assistance was being deployed and national guard troops were being prepared. In televised remarks today, President Bush urged people in threatened areas to evacuate to safe ground. Bush said, adding that everything possible would be done to help them.