1

Louisiana Hospital Responses  to Hurricanes Katrina and Gustav 

Knox Andress, BA, AD, RN, FAENDesignated Regional Coordinator 

Louisiana Region 7 Hospital PreparednessLSU Health Sciences Center ‐

Shreveport

The National Emergency Management Summit

2

Goal ‐

Objectives

• Goal

–– Demonstrate comparisons of impacts and responses 

to Hurricanes Katrina and Gustav by Louisiana  hospitals

• Objectives

–– Provide a background on storm dynamics and history– Discuss factors influencing hospital evacuation– Discuss numbers of partial and total hospital 

evacuations– Discuss impacts to hospitals in a sheltering region

3

4

Katrina Dynamics

• Hurricane Katrina –– Entered Gulf of Mexico –

August 26, 20051

– Predictions:  “Category 1”

projected to become a 

“Category 5”– Hurricane warnings:  Louisiana central coastline to Florida 

panhandle– Landfall: August 29, 2005; Burras, LA (Southeast 

Louisiana); “Category 3”

w/ 125 mph winds

– Storm surges: 10’

–

19’.   

– Levee breaches: = 53; 80% New Orleans & neighboring  parishes flooded. 

– Louisiana fatalities: 1,464 storm‐related; 135 missing2

– Estimated 100 billion dollars in LA property damage/loss3

5

Katrina: Predictions and History

6

Canal Breeches London Avenue Canal Industrial Canal

7

Hurricane Katrina – New Orleans 

8

Gustav: Predictions and History

9

Gustav Dynamics

• Hurricane Gustav

–– Entered: Gulf of Mexico – August 31, 20084

– Predictions: “Category 1”

projected to become a  “Category 5”

– Hurricane warnings: Cameron Parish to Ala/Fla

border– Landfall: September 1, 2008; Cocodrie, LA – (Central 

coastal Louisiana); “Category 2”

w/ 105 mph winds– Louisiana storm surges: 10 – 14 feet.   – Levee “topping”

‐

No (0) levee breaks

– Louisiana Fatalities: 48 storm‐related5

– Estimated 4.3 billion in LA property damage/loss

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Disaster Declarations in Louisiana 

• Katrina Declarations • Gustav Declarations

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Hurricane Impacts to hospitals

• Katrina– Wind 

– Catastrophic flooding

• Gustav– Wind

– Minimal flooding

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Gustav: Hospital Power Outages6

Hospital Region

Hospitals (G)

Region 1 1

Region 2 12

Region 3 5

Region 4 9

Region 5 0

Region 6 2

Region 7 0

Region 8 0

Region 9 1

TOTAL 30

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Gustav: Hospital Evacuation Breakdowns6

Hospital Region

Partial Evacs

Complete Evacs

Pre- landfall

Post- landfall

Pre + Post

Evacs

1 8 8 16 0 16

2 1 4 0 5 5

3 3 7 10 0 10

4 6 12 9 3 12

5 5 7 12 0 12

6 0 0 0 0 0

7 0 0 0 0 0

8 0 0 0 0 0

9 5 7 10 2 12

TOTAL 28 45 57 10 67

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Louisiana Hospital Evacuations – Katrina vs

Gustav6

Hurricane Gustav*

Pre Storm

Post Storm

Total

Total HospitalEvacuation

38 7 45

Partial HospitalEvacuation

25 3 28

Total 63 10 73

Hurricane Katrina

Pre Storm

Post Storm

Total

Total Hospital Evacuation

8 26 34

Partial Hospital Evacuation

5 5

Total 13 26 39

*Gustav ‐

approximately 1000 patients evacuated pre‐storm;                 

223 patients were evacuated post‐storm.

15

6

9

16

28 2930

32

-

5

10

15

20

25

30

35

Hospital D Hospital G Hospital E Hospital F Hospital A Hospital B Hospital C

Hours for Evaucation

Hospital Evacuation TimesHospital Evacuation TimesHurricane Rita Hurricane Rita –– September 2005September 2005

Benchmarking Hospitals for Hurricane Evacuations; Downey, E; Andress, K; Schulz, C; Prehospital and Disaster Medicine, 2007, V 22, No 3,

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Impacting Hospitals – Gustav: Nursing Home Power Outages6

Region Nursing Homes

(G)Region 1 0Region 2 12Region 3 2Region 4 0Region 5 0Region 6 0Region 7 0Region 8 0Region 9 1TOTAL 15

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Hurricane Gustav Pre Storm Post Storm Total

Complete Evacuation

94 2 96

Partial Evacuation 0 0 0

Total 94 2 96

Impacting Hospitals ‐Gustav: Nursing Home Evacuations6

8,401 residents evacuated pre‐storm; 160 residents evacuated post‐storm

State Regional InfrastructureState Regional Infrastructure

9 9 ‐‐Louisiana DHH Louisiana DHH Hospital Hospital Preparedness Preparedness RegionsRegionsRegion Region ‐‐ Designated     Designated     Regional Regional CoordinatorsCoordinators‐‐Hospitals/EMS/ Nursing Homes/Coroners /…

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Medical Institution Evacuation PlanWar‐Game Numbers of potential throughput6

Regions 4,5:     624 patients

Regions 3,4: 

343 patients

Regions 1,3,9:  1063 patients

Number of Parishes: 12Number of Hospitals: 60+

Anticipated Planning Range: low - high

343 - 1063 (reasonable “worst case” planning scenarios)

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Louisiana:  Transportation Evacuation Requirements for Hospitals6

Hospital Census Details NDMS Totals Vehicle Requirements

RegionsPost‐

Discharge 

Census

ICU CensusPatients 

Needing NDMS 

Evacuation

Patients 

needing 

Critical Care 

Transport 

Teams

AmbulancesPara‐

Transit 

Seats

Buses

1,3,91,3,9798798 5959 268268 1818 9191 264264 1414

3,43,4 316316 2727 168168 1010 4242 112112 11

4,54,5 601601 4040 207207 88 6868 207207 55

Census is for all hospitals that are SIP 2 or 3, and not EVAC Tier 1

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GUSTAV Medical Institution Evacuation: August 31, 20086

Region 5 AMPChennault Airport124 NDMS patients Regions 4

Acadiana

Airport34 Homebound patients 

Regions 1 AMPLakefront Airport302 NDMS patients 81 Homebound patients 

Regions 3Moved by ground/air 

ambulances the NDMS patients 

and homebound patients to 

Region 1 

•

State/ hospitals waited for almost two days before C‐130s and AE crews 

showed up at Region 5 AMP and Region 1 AMP.

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State

Number ofPatients

Total Number Received

Total Patients Deceased

Total Patients Left to beReceived

Total Patients in CareFlite

Que

Alabama 9 9 0 0 0

Arkansas 325 304 21 0 0

Kentucky 3 3 0 0 0

Mississippi 98 98 0 0 0

North Carolina 1 1 0 0 0

Oklahoma 30 29 1 0 0

Tennessee 8 8 0 0 0

Texas 86 84 2 0 0

Total 560 536 24 0 0

Repatriation of NDMS patients and

Medical Special Needs evacuees

Source: DHH Repatriation Call, October 2, 2008 (Kathy Kliebert)

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Planning and Responses: Pre Hurricane Katrina

• 20021.

Tropical Storm “Isidore”2.

Hurricane “Lili”

• 20031.

DHH Hurricane Annex “X”2.

DHH – Hospital – Sheltering 

MOU

3.

Hospital CEO Hurricane 

Checklist

1.

Tropical Storm “Bill”

• 20041.

Hurricane “Pam”

TTX 

planning

1.

Hurricane “Ivan”

• 20051.

Hurricane “Pam”

TTX2.

Hurricane Katrina and Rita 

AARs

1.

Hurricane “Dennis”2.

Hurricane “Cindy”3.

Hurricane “Katrina”4.

Hurricane “Rita”

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Planning and Responses: Post  Hurricane Katrina7

• 20071.

Region 1 and 9 MIEP Exercise2.

Region 3 MIEP Exercise3.

Region 5 MIEP Exercise4.

State‐wide Hurricane Exercise5.

Louisiana/Federal Joint 

Response Plan Update

6.

Neonatal Evacuation Form7.

Psychiatric Patient Movement 

Form

8.

Private Patient Movement Form9.

Shelter‐in‐Place 

Recommendations

1.

Hurricane “Dean”2.

Tropical Storm “Humberto”3.

Tropical Depression #10

• 20061.

Medical Institution Evacuation 

Plan (MIEP)

2.

EMSystem’s

–

EMResource3.

Patient Tracking Plan4.

“H‐Hour Calculator”5.

Louisiana Hospital Emergency 

Preparedness Network

6.

Louisiana/Federal Joint 

Response Plan

7.

EMS DRCs8.

Nursing Home DRCs9.

Katrina and Rita AARs

1.

Tropical Storm “Alberto”2.

Hurricane “Ernesto”

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Planning and Response:  Post Hurricane Katrina7

• 20081.

Regions 1, 3, and 9 MIEP 

Exercise

2.

Region 4 MIEP Exercise3.

State‐wide Hurricane Exercise4.

Hospital Aeromedical

Transfer 

Form

5.

Neonatal Transfer form6.

Patient Locator7.

Credentialing Procedures for 

LPNs, RNs, and MDs

8.

Hurricane “Gustav”

and “Ike”

AARs

1.

Tropical Storm “Eduard”2.

Hurricane “Gustav”3.

Hurricane “Ike”

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Primary and Secondary       Hurricane Hospital Impacts

1.

Primary

system impacts come from  evacuating hospital processes.

2.

Secondary

system impacts originate from  supporting:

– evacuating hospitals and 

– sheltering evacuee population

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Sheltering Impact to Hospitals ‐ Indicators

• Numbers of shelters• Types of shelters (Special Medical Needs; 

Critical Transportation Needs; General, etc.)• Length of operation• EMS shelter runs to hospitals• Types of medical complaints• “Diversion”

time by local hospitals

• Shelter medical resourcing

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Louisiana’s – Region 7

Natchitoches

Bienville

Sabine

Red River

De Soto

WebsterBossier

Caddo

ClaiborneShreveport & Bossier City

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Louisiana Region 7: Demographics

General Demographics:Region Population: 524,000 (Census 2000)Largest city ‐ Shreveport: 200,145 (Census 2000)Planning for surging 264 (500/100,000,000)Parishes: 9 in Northwest LouisianaNumber of hospitals: 28 (17 “Tier 1” and “11 Tier 2”)

(Tier 1 = hospitals  with emergency departments; Tier 2 = all other hospitals)

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CLAIRBORNE PARISH

•Homer Memorial Hospital (T1)

BIENVILLE PARISH

•Bienville Medical Center (T2)

WEBSTER PARISH

•Minden Medical Center (T1)

•Springhill Medical Center (T1)

RED RIVER PARISH

•CHRISTUS Coushatta (T1)

NATCHITOCHES PARISH

•Natchitoches Regional Med Center (T1)

•Natchitoches Parish Extended Extended

Care (T2)

DESOTO PARISH

•DeSoto Regional MC (T1)

CADDO PARISH

•Brentwood, A Behavior Health Company (T2)

•CHRISTUS Schumpert St Mary Place (T1)

BOSSIER PARISH

•Bossier Specialty Hospital (T2)

•Cornerstone Hospital (T2)

•Willis-Knighton Bossier (T1)

SABINE PARISH

•Sabine Medical Center (T1)

Region 7 Hospitals in 9 ParishesRegion 7 Hospitals in 9 Parishes

•CHRISTUS Schumpert Highland

(T1)

•Doctors’

Hospital of Shreveport (T2)

•Dubuis Hospital of Shreveport (T2)

•Promise Hospital of Shreveport (T2)

•LifeCare Hospital (T2)

•LSU-Health Sciences Center (T1)

•North Caddo Medical Center (T1)

•Overton Brooks VA Medical Center (T1)

•Specialists Hospital of Shreveport (T2)

•Shriners Hospitals for Children-

Shreveport (T2)

•Willis-Knighton Medical Center (T1)

•Willis Knighton Pierremont Health Center (T1)

•Willis-Knighton Health System South (T1)

Natchitoches

Bienville

Sabine

Red RiverDe Soto

WebsterBossier

Caddo

Claiborne

T1 = hospitals w EDs;                                   

T2 = all other hospitals

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Shelters in: Region 7’s Shreveport and Bossier City

Katrina Shelters

• General Shelters1.

LSU –

Shreveport

2.

Hirsh Coliseum

3.

CenturyTel Civic Center

4.

Southern University

5.

Expo Hall

• Special Medical Needs 

Shelters1.

Bossier Civic Center

Gustav Shelters• General Shelters

1.

LSU –

Shreveport2.

Southern University 3.

Riverview Center 4.

Century Tel Civic Center5.

Hirsh Coliseum• Critical Transportation Needs 

Shelters1.

Sam’s Club2.

The Sports Outlet Mall• Special Medical Needs 

Shelters1.

Bossier Civic Center

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Evacuees Reported in LA  Region 7 Hospitals8

33

Region 7/ Gustav Hospital Evacuee   Patients Came From…

465

89

152

9

Shelter

Home

Hospitals

NH

34

EMS Transports:  Shelters to  Shreveport‐

Bossier City Hospitals 

75

5356

32

0 0

6

63

33

0

10

20

30

40

50

60

70

80

CTNS Shelter - Sports Outlet

Mall

CTNS Shelter - Sam's Club

SMNS -Bossier Civic

Center

Red Cross/General Shelter Hirsch

Red Cross/General Shelter LSUS

Red Cross/General

Shelter Southern University

Riverview -Shreveport

CenturyTel Other

Run

s

Shelter

Evacuee Impact on Hospitals: Medical Service Runs from Shelters to Area Hospitals, Aug. 30 - Sept. 18 (Fig. B)

35

Daily EMS Transports ‐

Shelters to  Shreveport – Bossier City Hospitals

1

67

5754

57

36

16

52 2 1 0 2

11

2 2 2 0 0 10

10

20

30

40

50

60

70

80

8/30 8/31 9/1 9/2 9/3 9/4 9/5 9/6 9/7 9/8 9/9 9/10 9/11 9/12 9/13 9/14 9/15 9/16 9/17 9/18

Run

s M

ade

Date

Evacuee Impact on Hospitals: Medical Service Runs From Shelters to Area Hospitals, Aug. 30 - Sept. 18, 2008

36

Shelter Transports –

Complaint Types

3522 15 14 21 16 13

124

0

50

100

150

Complaint Types

Tra

ns

po

rt #

Biotel-Routed Shelter TransportsChest Pain

SOB

Diabetic

O.B.

Abd Pain

Trauma

Seizure

Other

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Sheltering Impact – Hospital Diversion9

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Issues• Patient tracking processes• Hospital data collection and reporting• Repatriation –

instate; out‐of‐state

• Infrastructure (HVAC, fuel, ice, etc)  for hospitals  sheltering‐in‐place (“SIPing”)

• Pharmaceuticals for shelters• Level‐of‐care delivery in shelters• Patient size (bariatric issues)• Question ‐

Future hurricane evacuations?

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References

1.

Knabb, R; Rhane, J; Brown, D; Tropical Cyclone Report, National 

Hurricane Center, December 20, 2005

2.

Hurricane Katrina, Deceased reports, Louisiana Department of 

Health and Hospitals; accessed February 2, 2009 @ 

www.dhh.louisiana.gov/offices/page.asp?ID=192&Detail=5238

3.

Louisiana Recovery Authority, Briefing, August 24, 2007 

4.

Brown, J; Kimberlain, T; Tropical Cyclone Report, National 

Hurricane Center, January 22, 2009

5.

Hurricane Gustav; Wikipedia; accessed Feb 13, 2009,    

www.wikipedia.org/wiki/Hurricane_Gustav_(2008)

6.

Hurricane Gustav and Ike, Louisiana ESF‐8, Health and Medical 

Response After‐Action‐Report; Louisiana Department of Health 

and Hospitals; November 5, 2008.

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References7.

Hurricane Information for Hospitals; HHS Emergency 

Preparedness; Louisiana Hospital Association; accessed January 

28, 2009; 

www.lhaonline.org/displaycommon.cfm?an=1&subarticlebr=337

8.

Hurricane Gustav and Ike, Region 7 Hospitals After‐Action‐

Report; Shriners Hospital for Children; October 9, 2008; 

Shreveport, LA

9.

ED Status Report; Shreveport‐Bossier City Tier 1 hospitals, 

EMSystem EMResource, for August 28 – September 6, 2008 

10.

Louisiana Shelter Summit Report; Department of Social Services; 

October 27, 2008; Shreveport, LA; accessed February 10, 2009; 

http://www.dss.state.la.us/assets/docs/searchable/OS/Reports/

021609ShelterSummitReport.pdf

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Thank you!

Knox Andress, BA, AD, RN, FAEN

Designated Regional Coordinator

Louisiana Region 7 Hospital Preparedness

Of (318) 813‐3311; Fax (318) 813‐3318

wandr1@lsuhsc.edu