Dr. Ken Mattox
Dr. Mattox was heavily involved in the disaster response efforts in the Houston area. He described a national trauma network through which communication with trauma specialists in New Orleans regularly occurred:
"Being a trauma surgeon, the most sophisticated integrated, collaborative network of disaster response in the world is among the trauma systems in the United States put together by the American College of Surgeons Committee on Trauma. And that’s been in place now since the mid or late 1970s. It is a linkage where the directors of trauma programs in each state, each region, and in each designated trauma center literally know each other, and it’s an extremely sophisticated hierarchical activity. That system in New Orleans and the system in Houston often talk to each other; hardly a week passes that we haven’t talked to each other. . ."
"The best thing that every hospital can do is lock into the trauma network that exists in every state. Because of petty jealousies in almost every state in this Union except Connecticut, the public health people want to run the disaster and they summarily have excluded the trauma network [see Implications for Policy section for Dr. Lenworth Jacob’s explanation of the Connecticut model]. . . There’s been a lot of people who emerge and want to be the hero during a disaster. Unfortunately or fortunately, we do not have enough disasters for all of the people who think they are experts and should get credit. You really don’t need a big group to make things be successful. In Houston, our management group was composed of about 35 people, and they were all local people. And these were people in charge of security, logistics, volunteers, medical supplies and disposal, just like the various branches of the city. You don’t need a very big group. "
"And in Louisiana, you have triple the number of special interest groups that are now ready to emerge as being the boss during the next disaster in Louisiana. Most of these have never ever been in the trenches. Most of them have gone to a bunch of courses and learned a bunch of words, but when it comes to the real action, when they get their shoes dirty and get their pants dirty and they can’t take a shower for four days, they aren’t very functional. The people who have lived through multiple disasters are summarily excluded from being part of these planning groups because the folks who made disaster a part of their profession or who have come along to try and be the Johnny Come Lately really haven’t been there. Like someone reading a book about brain surgery becoming a brain surgeon. It takes a certain amount of internship, residency, and supervision; and then you come out and you’re pretty good. Twenty-five percent of everything FEMA declares to be a disaster occurs along the upper Texas coast, of those that occur in the United States. Whether it is refinery fires, explosions, pile ups-on the freeway, chemical exposure in a plant, or a hurricane, 25% of United States’ disasters are in the Houston, Galveston, Matagorda, Beaumont area. So one of the advantages we had when we met on that Wednesday morning, we looked around the room and we said, "We’ve been there, done that," and we already know each other. . . "
"Well, we first assessed what [were] going to be the needs, what kind of people [were] we going to be getting. We knew [what] the medical response [would be]. We decided early we were not going to overload our existing emergency departments. You may have seen in the paper and the television [recently]; the Waxman Commission in Washington said the cities in the United States are not ready [for a disaster]. They absolutely missed the point on what you can do locally. "
"We decided locally that we were not going to surge our emergency rooms since this is basically a clinic operation, not trauma; this was not burns; this was not infectious disease. So we established a secondary clinic. When people called in and said "We want to bring a DMAT unit. We want to bring an EMDS unit. We want to bring a military unit," we had more resources than we needed as happens with every disaster. We told people, "Don’t come to Houston. Set up your own shelter and by day three, we will secondarily send you people. So when we got calls from Tyler, TX, from Mid-land, TX, from Amarillo, from Denver, "We’re coming to Houston to help you," we said, "We don’t need help." By twelve hours into our planning, twelve hours before we got the first patient, we already had doctors and nurses scheduled for our clinic for the next fourteen days."
According to Dr. Mattox, the best possibility of successfully managing an emergency entails an immediate, efficient, and effective response at the local community level:
"Every disaster that has been successful has been solved locally within the first forty-eight hours. And outside help, be it DMAT teams, EMDS, FEMA, or whoever, really don’t do anything as far as the medical response and the immediate needs of preserving a society locally."
Dr. Mattox of Texas explained Louisiana could have been better prepared for a likely communication problem:
"There are always communication glitches; New Orleans had not prepared for that. We had eight different redundant communication backup systems to be able to link with each other. I was able to, through our trauma link, link to several different surgeons in Louisiana, Arkansas, Oklahoma, New Mexico, and throughout Texas. And we [were able to link] at least twice a day, whether we had messages or not. We did the linkages through Blackberries. So the ability to communicate was there, it was just not organized. And the leaders did not make certain assumptions."
Dr. Mattox described the process that he and others followed in preparing for and responding to the influx of evacuees from Hurricanes Katrina and Rita:
"The interaction with Katrina began about Thursday before Katrina hit New Orleans. Being a trauma surgeon, the most sophisticated integrated, collaborative network of disaster response in the world is among the trauma systems in the United States put together by the American College of Surgeons Committee on Trauma. And that’s been in place now since the mid or late nineteen-seventies. It is a linkage where the directors of trauma programs in each state, each region, and in each designated trauma center literally know each other and it’s an extremely sophisticated hierarchical activity. That system in New Orleans and the system in Houston often talk to each other. Hardly a week passes that we haven’t talked to each other. I was talking to the trauma directors at both LSU and Tulane because we were sort of joking; it’s long overdue, one of our cities is going to get hit and this hurricane looks like it’s coming. So we were even at that point, talking about what we had in the hospitals, what we needed for back up, what the communication mechanisms were, how one would we would evacuate and how would integrate with each other and with other trauma networks. We activated a trauma physician-directed trauma network for this five state region about Friday I think. And then twice a day, that physician network [allowed physicians to] interact with each other. It’s the same network that was activated when there was the school shooting at Virginia Tech, when the bridge collapsed in Minnesota. Any time there is that type of activity, when there were the earthquakes in Reno, we activate this system and test it and make sure we’re all on line and we have current networks and we used basically computers, Blackberries, and the like. So that was all in place long before Katrina hit. After Katrina hit, we were still in contact through phone, through internet on what was happening in the hospitals. We had our own systems that were meeting in Houston for our own Houston responses. Then on Wednesday morning about 6:00 a.m., about twenty of us received a phone call from the mayor and the County Judge that said we need you to meet at a location in Houston where we normally coordinate disasters and talk about receiving the evacuees from New Orleans. That group ultimately rose to about thirty-five or forty, and my role was co-medical director. We answered to an incident command, called a joint unified command. We called it a joint unified command because it represented probably close to sixty different entities. Hospitals, governmental entities, hospital entities, volunteer entities, all of these were local groups and the joint incident command was put together to cut through all of the silos, all of the red tape, all the personalities. The joint unified command was an independent power unit that was not controlled by previous special interest or previous political or economic motivations. And we said our mission is to receive the individuals who we need to bring to Houston and put them in shelters. The Reliant Astrodome, only being one of multiple locations, to asses them medically, and to quickly disseminate them in the community, into secondary shelters, into education, and to take account of their cultural, social, religious, medical, and work needs. And so we met and probably the singular most significant factor in the success was that we, although we came from multiple different groups, we destroyed those silos and looked at the plans that everybody had and found that none of them fit. We wrote a new set of plans and we said we all had been in disasters before. We knew that disaster response is virtually always local and it was local for at least seventy-two hours. We said we’re going to do this, and we have to do this ourselves, and we did it locally with local resources and then put together our plan and carried it out."
"That’s sort of an overview of why it worked. We had the support of the mayor, the County Judge, and the governor and the promise that they were not going to meddle in our business and we were going to make it happen."
Dr. Mattox highlighted the importance of financial resources in responding to a disaster: "The hospitals in Louisiana that had monied patients actually didn’t have a whole lot of sick people and those people got out the first day because there was insurance that could fly them somewhere. And they were able to communicate."
According to Dr. Mattox, the most effective response occurs quickly and efficiently at the local level:
"Every disaster that has been successful has been solved locally within the first forty-eight hours. And outside help, be it DMAT teams, EMDS, FEMA, or whoever, really don’t do anything as far as the medical response and the immediate needs of preserving a society locally. . . Outside resources are almost never needed."
As noted previously, the extent of devastation caused in the aftermath of Hurricane Katrina resulted from the levee breach. According to Dr. Mattox, it is very likely this level of devastation could have been averted:
"Fifteen months before Katrina, you had a table-top disaster drill that projected almost identical situations that occurred following Katrina. The people doing the disaster drill, the people at the state and the people in the trenches, didn’t even communicate the outcome of that drill. Plus, in Louisiana, you had received monies, lots of monies, to address the issues that had come up regarding the [levees]. Money was given to fix those levees. You know where that money went? It went to provide the plasma screens in the gambling casinos because the logic was, "If we make the casinos, we’ll generate monies that we can use in the future to fix the levees." And the world knows that. So, you created part of your own problems by diverting monies to fix the problem through gambling, and you know where that money went? Into the pockets of the people who own the casinos."