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Doctors Say Katrina Showed WMD Response Failings By Joe Fiorill WASHINGTON — Hurricane Katrina showed that the United States must improve its medical response plans for a nuclear or biological attack, emergency doctors told a House of Representatives subcommittee yesterday (see GSN, Oct. 19). The response to Katrina included a comparatively small medical component but still strained the medical system, leaving hospitals and other facilities understaffed and underequipped, said the witnesses. Fifty disaster teams dispatched by the Federal Emergency Management Agency, senior committee Democrat Bennie Thompson (Miss.) added, saw their effectiveness limited by inadequate federal coordination of their work. Such weaknesses could prove deadly in the much larger medical response to a WMD attack, the experts told the Homeland Security Prevention of Nuclear and Biological Attack Subcommittee. “Katrina exposes systemic problems in local, state, federal and military response coordination — problems that will be much more severe and have much more negative outcomes in the event of a terrorist attack in multiple cities,” said National Defense University technology and security researcher Donald Thompson, a medical doctor. The doctors presented the subcommittee with scores of suggestions for improvement, including heightened federal ability to act without waiting for a state’s request and stronger coordination of hospitals’ work during an attack or other disaster. Hypermed Inc. President Jenny Freeman, a surgeon who is part of a National Disaster Medical System team, described the experience of colleague Tim Crowley, who resigned from another federal team in frustration after returning from his post-Katrina deployment in Louisiana. “As a thoughtful and competent physician who wound up in a command position, the disorganization that prevented him from providing useful patient care was highly problematic,” Freeman said. “Over and over again, he saw physician and medical resources squandered. His team remained in Baton Rouge, being told there was no mission, while the staff at the key West Jefferson location were crying for help.” Like the other witnesses at the hearing, Freeman called for a stronger federal hand in disaster response planning and execution. “There is a genuine need and role for NDMS in responding to a disaster, and it is the role of the federal government to provide the guidance, support and impetus for this mission to occur,” she said. “Until we have clear, rational and accurate guidance as to what we as medical professionals will be required to train and prepare for, we will all act as individuals, doing the best we can in an extremely suboptimal manner, and the result will continue to be significant injury and death.” University of Texas public health-emergency expert Richard Bradley, who is emergency medicine director at Lyndon Baines Johnson General Hospital in Houston, said local governments’ authority in crises could be strengthened to improve hospital performance. Local emergency managers, he said, are responsible for overall emergency response but have no authority over hospitals and doctors. “The emergency manager … is responsible for ensuring hospital care is available but has no authority over the hospitals to compel them to respond,” Bradley said. “It is clearly in the public interest to address this problem at a national level.” Local governments, Bradley said, should draw up memorandums of understanding with hospitals that cover staffing, bed distribution and other procedures in a crisis. Authority to invoke the memorandums’ provisions should rest with emergency managers, he said. Committee members and witnesses expressed frustration about what they called continued ambiguity in the lines of authority laid out in the new National Response Plan, which is intended to guide disaster response at all government levels. In a bid to better coordinate general and medical emergency preparedness, Homeland Security Secretary Michael Chertoff has created a specific Preparedness Directorate in his department and has hired a chief medical officer. Thompson and top subcommittee Democrat James Langevin (R.I.) wrote Chertoff a letter yesterday questioning whether Homeland Security is prepared for an epidemic of a disease such as avian influenza. The lawmakers requested elaboration of the national plan’s Biological Incident Annex, which governs both naturally occurring and maliciously initiated outbreaks.
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