US Hurricane Disaster Preparedness and Health Policy Reform

Introduction

The health policy relating to U.S. disaster preparedness — or lack thereof — with respect to hurricanes is one that must include a better system of communication between U.S. disaster response teams and the hospitals in affected regions. As Hurricane Katrina showed, the United States was not prepared to handle the level of response needed in the wake of the catastrophe the hurricane produced. The problems with the response to Katrina were numerous: there was no National Response Plan (NRP) in place and no National Incident Management System (NIMS) in existence. Additionally, the Federal Emergency Management Agency (FEMA) was virtually ineffective — it had been in decline for years, was suffering from significant turnover among top leaders, and the individuals in charge lacked the appropriate leadership experience and knowledge to oversee an effective response to a natural disaster of Katrina's magnitude (Lewis, 2009; Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina, 2006).

Many lessons have been learned since Katrina that have enabled the United States to be better prepared to handle hurricanes and ensure that healthcare facilities are ready to treat those in need. This policy brief describes the health policy issue, its impact on access, cost, and quality of care; what the policy would do to ensure better access; what some of the potential unintended outcomes of the policy might be; and which stakeholders are likely to support or oppose the policy and why.

The Policy: Coordination Between Agencies and Hospitals

The policy under discussion addresses the problem of preparedness and a lack of coordination between response agencies and local area hospitals. To provide care for people during an emergency situation such as a hurricane, proper precautions must be followed and a protocol must be developed that all stakeholders can appreciate and abide by. What this policy calls for is interagency collaboration to ensure that effective, quality care is delivered to those in need during a hurricane disaster.

This is an important policy because, as Katrina showed, only agencies motivated by a cohesive spirit perform well. First, FEMA had inadequately trained staff, and New Orleans' Incident Command System (ICS) was not ready or prepared to respond to a disaster like Katrina — a failure attributable to leadership under both Director Michael Brown, who resigned shortly after Katrina, and New Orleans' local government. Second, FEMA was unable to provide adequate shelter for all those affected by the hurricane and the subsequent flooding, a direct result of leadership's failure to organize. Third, leadership failed to provide adequate logistics in handling the response and had to rely on the U.S. Coast Guard to accomplish anything of substance in the aftermath (Samaan & Verneuil, 2009).

The U.S. Coast Guard excelled and surpassed expectations in the wake of Katrina because it acted as an independent, autonomous organization with a single purpose and spirit of mission (Samaan & Verneuil, 2009). This type of spirit, vision, organization, and independence was precisely what FEMA needed to demonstrate in order to show it was ready. Today, there is a need for greater coordination among hospitals in hurricane-affected regions and federal, state, and local planners and responders, so that facilities can be ready to accept patients and provide care when an emergency has been declared. There is also a need to determine whether the federal government is shouldering the cost of care in emergency situations, whether access to care can be improved through interagency collaboration, and whether quality of care can be improved.

Intended Outcomes of the Policy

This policy would allow hospitals to accept patients during a hurricane emergency, with federal permission to provide treatment using emergency declaration funds. However, it requires that adequate correspondence and collaboration be conducted between healthcare facilities and responding agencies so that adequate care is available for patients impacted by a hurricane. This is essential to the policy's success.

As an example of effective interagency collaboration, consider the model demonstrated under Admiral Allen of the U.S. Coast Guard, who managed a successful collaboration across all three levels of agency response. As The Brookings Institution (2007) noted, "the Coast Guard rescue teams had pulled roughly 33,000 stranded Katrina victims off rooftops and overpasses. [Admiral Allen] was personally responsible for injecting some capacity for interoperability among the various civilian agencies at different levels — local, state, and federal — integrating with that an effective military response" (p. 3). This collaboration was pivotal to the response because it brought civilian agencies in line with the Coast Guard to allow all of them to pursue one objective: to rescue thousands of stranded persons and get them to shelter. Hospitals were not involved in the treatment of many people because of bureaucratic delays and problems establishing effective lines of communication.

In order to avoid a lack of collaboration between response agencies and healthcare facilities — which can negatively impact the overall response to a disaster — this policy would establish a regulation protocol by which healthcare facilities play a more active role in collaboration. In the past, the Department of Defense (DOD) and FEMA have waited for information to be processed before beginning to respond. FEMA and the DOD should have pre-planning exercises in place with healthcare facilities, allowing bureaucratic red tape to be cleared as quickly as possible. FEMA should have obtained military authorization ahead of time so that when a hurricane landed with the anticipated force, the military could respond with a simple phone call, enabling a joint military and healthcare response to be deployed on a large scale as quickly as possible (Philipps, 2017). This would increase the likelihood of quality care being delivered during and after a hurricane. Access to care would be greatly improved, the cost of obtaining care would be funded by emergency declaration funds, and quality of care would be enhanced.

Conclusion: The Case for Congressional Support

Voting to support this policy should be the top priority for everyone in Congress, as it will be a positive step in bridging the gap between current healthcare facilities and the agency response teams tasked with developing appropriate plans for hurricane disasters. By supporting and voting for this policy, Congress will be able to show constituents that it has put their best interests first. A policy such as this would create greater cohesion and better communication among the most important players in delivering healthcare effectively to hurricane victims.

References

The Brookings Institution. (2007). 9/11, Katrina and the future of interagency disaster response. Retrieved from https://www.brookings.edu

Lewis, D. E. (2009). Revisiting the administrative presidency: Policy, patronage, and agency competence. Presidential Studies Quarterly, 39(1), 60–73.

Philipps, D. (2017). Seven hard lessons responders to Harvey learned from Katrina. The New York Times.

Samaan, J. L., & Verneuil, L. (2009). Civil–military relations in Hurricane Katrina: A case study on crisis management in natural disaster response. In Humanitarian Assistance: Improving US-European Cooperation. Center for Transatlantic Relations/Johns Hopkins University, Baltimore, MD / Global Public Policy Institute, Berlin, 413–432.

Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina. (2006). A failure of initiative. Retrieved from http://govinfo.library.unt.edu