Dr. William Cassidy
Dr. Cassidy described the networking, coordinating, and teamwork that was critical in setting up a field hospital at Kmart to accommodate those with less critical health issues. When they first entered the space, it was filthy and had to be cleaned up to function as a field hospital:
"So [Mark] Lumpkin had gotten like 100 volunteers to come. People from Healing Place and Chapel on the Campus started showing up. And moving stuff in. The engineers – several of my engineers, a great group . . . The whole group, just incredible. And that’s the thing when you have a church is you have some 50-year-old guy like me who is a contractor and you have somebody else that knows somebody that you can rent the equipment from and you have somebody else that knows how to get somebody to do wiring."
"So the volunteers swept it out. They got these little cranes that you stand in and it goes up and down . . . and they hung everything, replaced all of the bulbs. . .They went to Home Depot and got Home Depot to donate on promise of payment like 500 bulbs, fluorescent – 6-foot-long fluorescent bulbs to replace them out as well as the visqueen to divide it up. . . . we walked through and said, "This is how we need to divide it up. This will be intake. This will be registration. This will be where people sit while registering. This will be for patients to sleep. This will be clothes. This will be food. This will be pharmacy." So we did a walk-through and then that night they implemented the plan. I went home and slept. And the next day they came back and the stuff – the tractor trailers had arrived, stuff off-loaded, cots set up, etc."
Dr. Cassidy described a more comprehensive national electronic communication system to track patients, access medical records, and coordinate emergency response efforts:
"Disaster.Com. Debbie Lumpkin . . . a very talented woman . . . said, "What we need is a travel agent software package where, if there is a nursing home that can do dialysis in Louisville, and there is a plane in Jackson, Mississippi that can transport them, and there is an ambulance across town that can take the person to the airport, everybody can plug in their resources so that when you put up and say, ‘I’ve got three nursing home patients that need dialysis,’ you can pick and choose from available resources and assign them and they can take care of it. That would eliminate the need to have your cell phone as the point of linkage with someone in Louisville, and someone at the ambulance service who you may or may not know exists."
"You know, I ended up having a great deal of contacts in my head that day – my notebook – but if I had died you would have had to restart. So there is a – so I like to call it Disaster.Com. So similarly, when someone has a barcode put on their wrist as a "get on the bus in New Orleans," you could scan them when they hit the PMAC and it goes to Disaster.Com. You now know where John Smith, III is. But if John Smith, III gets off in Utah, you scan it and you know that he’s in Utah. A woman named Cathy Greene worked tirelessly to reconnect families, but she was working for months after [the storm]."
Dr. Cassidy described how difficult it was during the crisis to coordinate through a sometimes chaotic central command system:
"Someone called in and said "We will drop-ship computers with satellite communication so that instead of relying upon broken systems you can beam it to the satellite and everybody can be linked by internet," and she said that no one could make the call. . . People were so overwhelmed they couldn’t make a call on even something as straightforward as that."
"So I actually think the appropriate planning is not to have some central command that everything has to flow through. . . I can give you example after example how they got overwhelmed at their central command. A health care worker is going to wait for six hours to finally get clocked in and the central command not knowing where they should go because no one could reach central command because their lines were always busy and there was no internet connection. Going back to the need for Disaster.Com, I would call up and say, "Hey, I need some nurses, Okay," and they would just skip central command. There ended up being this informal horizontal network of people connecting that was independent of the command and control structure. A command and control structure has its place, but was clearly overwhelmed and they kept wanting to have control until, [eventually] somebody with wisdom would say, "No, let it happen."
"I compare the two to a Communist system, a centrally planned economy, versus a capitalistic economy. A centrally planned economy works on a very small scale with some very bright people. A capitalistic economy sets the rules in place, sets an infrastructure of communication and of honesty and then allows independent operators to respond to the market."
"Now, that’s actually a better way to do it, in my mind, particularly if you have Disaster.Com which allows the people to communicate. . . You set up generators, computers hooked to generators for power with satellite communication that immediately let you go to Disaster.Com and that’s your home page. You come up and you say, "Okay, Search." Put in a name, put in a service, and put in a location –"
"But you think about how Disaster.Com can help with tracking people, for allowing the marketplace, if you will, to respond to where the needs are. . . You can have centralized command, but once you get the rules going you de-centralize. There is a lot of expertise out there that exceeds the expertise of the people doing the planning."
"Your nephrologist knows more about kidney problems and getting people to dialysis and where dialysis units are than the person who will be executing the decision to evacuate patients. Your nephrologist may or may not have been involved with your initial plans, so you can’t say, "Oh, my gosh. We need to have a nephrologist and a dialysis unit ready all during hurricane season." It’s an incredible waste of resources. What you do need, though, is a way to say, "Okay. Bill Cassidy or Angie Johnson, we need you to think of a medical type disaster, what services do you need," and then if you have a connector in place, and I know lots of people that meet my definition of a connector, I call Robert Kenney and I say, "Robert, I need Nephrology. Can you take this on?" I can call up Cullen Hebert, "Cullen, I’ve got ventilator patients flowing into town. Can you help me? You can’t? Who can?" Just like my administrator pastor at church knew the plumbers, knew the electricians, knew the fire marshal. Just like my insurance man knew the volunteers, knew where to get light bulbs, where to get this and that. So you need your medical staff who is connected. . . They had that at the hospitals . . ."
"You need federal special forces disaster relief. By that, I’m using the analogy of what the Army did in Iraq and Afghanistan. A very small number of people who could drop behind enemy lines and shine the laser at 600 yards to guide the fellow who is not really trained at anything but dropping a bomb on a laser, to bring that resource, if you will, the point on where it needed to be."
"So if you had a group of 600 computer-savvy Disaster.Com people who would come in – parachute in, if you will, to the place, set up the generator, check up the computer system and them begin to – and have Google maps and begin to plot out, as people would be all over – I mean, you could log on any place and say, "There’s trees across 90. No, the trees have been cleared," so everybody can be logging on but there would be one person saying, "Okay. This is the Disaster Relief Center. This is how the software works. Tell me what you need." "Click in. We need 16 truckloads of water in Covington." Click, click, click, click. Now, somebody in Bogalusa has 16 truckloads of water and begins to move it."
"So you scatter these people at key points and they would be your special forces who would be basically there for communication, because I’d like to say that the first casualty of a disaster is organization and the second is communication and the two are related. So, if you have them keeping you communicating, your organization automatically improves. They are sending you information back, they are saying, "Listen, we have reports of gunshot wounds. Is it true? E-mail back via the satellite. Not true. I’m on ground and no gunshot wounds." So you have that. And they are there to keep their head cool when everybody else is panicking. "