Survey Data  ·  Focus Groups  ·  Key Findings  ·  Limitations

Purpose of the Study

Three years after Hurricanes Katrina and Rita pounded the Louisiana coast, the medical infrastructure of south Louisiana, particularly the greater New Orleans metropolitan area, is slowly rebuilding. The impact of these storms on the medical profession in Louisiana has been unprecedented. The purpose of this study is to summarize the nature of that impact and the lessons learned for the medical profession at large regarding preparation for and response to natural and man-made disasters.

Methods

Three different methods were used to explore the perceptions of medical professionals regarding the impact of Hurricanes Katrina and Rita on the medical infrastructure in southern Louisiana. First, a survey was developed that was available on-line and by standard mail. The survey was developed both to collect factual information about physicians, such as the type of practice they had prior to Katrina and Rita, and specific ways in which their practice might have been affected. Secondly, a standardized protocol was developed to conduct focus groups with diverse groups of doctors throughout south Louisiana. These questions were aimed at the identification of key issues, such as the impact of the storms upon the physicians and the physicians’ views of the disaster response, such as what went well, what failed, and what suggestions they had for the future. See Appendix A for the interview format for the focus groups. Third, an interview protocol was developed to conduct face-to-face or telephone interviews with selected medical professionals (see Appendix B). A list of potential interviewees was developed by the Louisiana State Medical Society (LSMS) and respondents in the survey who indicated they would be willing to be interviewed. However, as the interviews progressed, the list of referrals expanded to include a wider range of professionals, including physicians, directors of parish medical societies, hospital administrators, public health administrators, and disaster experts. Although the underlying core of the interview protocol was as consistent as possible, the participants varied greatly in their professional roles and extent of direct experience with the medical impact of the hurricanes.

The protocol served as a foundation upon which the interviews were tailored to capture the unique experiences and perspectives of each participant. The common framework included questions concerning the following: (1) the extent and adequacy of preparation for the impending hurricanes; (2) the immediate as well as long-term impact of the hurricanes; (3) the types and effectiveness of the response to the disasters; and (4) recommendations for change. Probing questions were used to gain further depth of information appropriate to unique experiences, such as advocating for the needs of the indigent. See Appendix B for the protocols that were administered to physicians in private practice or hospital settings, physicians who were engaged in caring for evacuees in various shelters, and directors of parish medical societies.

Also, three disaster response experts outside of Louisiana were interviewed. Their interviews were more focused on what went well in Louisiana’s disaster responses to Katrina and Rita and what recommendations could aid in a more effective response to future natural or man-made disasters. The resulting personal accounts of men and women, who provided the medical response through one venue or another, have provided a wealth of information from which much can be learned.

Finally, data from all of the sources were used to summarize the aspects of the preparation for, impact of, and response to Hurricanes Katrina and Rita as they pertain to the medical infrastructure of southern Louisiana. This was done in order to develop recommendations for other states to consider when planning for a disaster and to identify the numerous policy related issues that other communities and states may want to consider when updating or revising their disaster plans.

Survey Data

In order to assess the perceived performance of the medical community during and immediately after the storms, a survey instrument was created and then administered to the LSMS community. The overall construction of this survey was accomplished through a review of existing surveys, including one developed by the LSMS immediately after Hurricanes Katrina and Rita, and through discussion with LSMS staff and members of the medical community. Previous disaster service surveys were used as blueprints for the creation of the most recent survey. Questions were then added to fit the specific circumstances that the hurricanes forced Louisiana's medical professionals to meet. Finally, drafts of the survey were distributed to medical professionals to check for consistent medical terminology as well as information of interest. These professionals became ineligible to participate in the survey. The entire survey may be seen in Appendix C.

A random sample was created using an LSMS member list. Over 1,000 members were chosen to take part in this study. A hard copy of the survey was mailed to each potential respondent along with directions and an address was provided for return of completed surveys. In addition, a website link was provided that would allow the medical professional to take the same survey online. In an attempt to increase responses, two separate reminder cards were sent out before the survey due date. These efforts obtained approximately 230 responses for any one given survey question; 170 were hard copies mailed back to LSU and the remaining responses were completed using the online form.

In an effort to see what type of doctor would be the primary respondent on this survey, the question was asked "What was your primary practice prior to the hurricane?" As Chart 1 shows, over two-thirds of all respondents were in private practice at the time of the hurricanes. It was also important to ascertain what sort of damage each respondent's primary care center had received due to the hurricanes (Chart 2).

Respondents were asked directly about the length of time their practice was unavailable and although Chart 3 shows some variance, it is clear that it was most common for a practice to be unavailable for 2 weeks to one month.

Charts 5 and 6 shows some interesting demographics about the respondents and should be taken into consideration when looking at these results. Most of those who responded were direct medical practitioners as opposed to administrators. In addition, over 85% of the surveys returned were completed by a male respondent.

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Focus Groups

Methodology

At the suggestion of the LSMS staff, the Executive Directors of selected parish medical societies were contacted for assistance with finding physician participants from the Katrina and Rita impacted areas. Based on feedback from the Executive Directors, it was determined that focus groups would be held over lunch or during early evening time periods with refreshments.

The Executive Directors were also asked to supply names of physicians to participate in the focus groups. In addition, a list of physicians who had completed an LSMS survey soon after the 2005 storms, and who had indicated a willingness to provide further information was provided by LSMS. Letters introducing the project and encouraging participation were mailed from LSMS to the physicians and to those suggested by the Executive Directors.

Staff called the physician’s office to check availability and followed up with a fax with the details indicating the focus group date, time and location. Numerous calls were made to gain participation. Subsequently, calls were made to remind participants of the date, time and location of focus group meetings. The majority of the focus groups were conducted at hospital meeting rooms for the convenience of participants and to increase attendance by physicians. All focus group discussions were guided by open ended, semi-structured questions.

Three basic questions for the focus groups were developed as standard protocol to be used with all participants. These were:

1. What worked well in your efforts to respond to medical needs following the hurricane?

2. Based on your experience, what did not work well? What were the challenges you faced in responding to medical needs?

3. What would have helped you respond to the situation?

Six focus groups were conducted. A seventh focus group was also scheduled, but only one person was present. Thus, that individual data is reported along with the data of the six focus groups. Twenty-seven health care professionals participated. Focus groups were held in Lake Charles, New Orleans, Baton Rouge, Lacombe and St. Bernard Parishes.

Key Findings

Based on the responses from the participants, the three key areas mentioned were: 1) lack of communication and planning, 2) lack of clarity regarding which entity had authority, and 3) lack of necessary resources (medicines, materials, transportation, etc.) for medical needs of people.

1. Lack of Communication and Planning. Communication equipment was rendered useless in most cases as a result of both hurricanes. The ability to communicate varied from use of phones, personal cellular phones, texting from personal cell phones, satellite phones, walkie talkies, and radio communication. With limited communication ability, physicians attempting to respond to medical needs relied on what was on hand.

   In most cases, it was not known which hospitals, clinics, or health units had power, water, and supplies. Therefore, the question of where to send patients with specific medical needs was not clear. As a result, functioning facilities were underutilized.

2. Lack of Clarity Regarding Which Entity had Authority. In every locale, the local government or citizens themselves provided the initial disaster response. In many cases, the Red Cross arrived followed by FEMA. Once martial law was instituted, the National Guard and other military personnel became the entity with authority. Participants reported encountering different procedures, rules and processes as the entity with authority changed. This made it challenging for medical responders to know what to do. Participants noted that hospital administration is generally responsible for ensuring that the facility has proper resources to operate if the facility remains open.

3. Lack of Necessary Resources for Medical Needs. Physicians from Tulane reported running intensive care patients on limited generator power while the remainder of the facility had no power. The majority of the medical needs were not caused directly by the storm but were related to ongoing health issues such as high blood pressure and diabetes. Evacuees did not have enough medication, did not bring their medication, and/or did not know the name or dosage of their medication. Focus group participants reported that, after giving out medications on hand to evacuees, they relied on samples from their private practices and/or resorted to obtaining medications from community clinics and pharmacies.

The availability of power, water, food, medicines, supplies and transportation varied from site to site. Help (fuel, manpower, materials, etc.) was often diverted or turned away by officials.

Limitations