Vulnerable Populations and Public Health Emergencies Lessons from Hurricane Katrina LuAnn E. White, PhD, DABT Tulane Center for Applied Environmental Public Health November 4, 2006 Hurricane Katrina August 29, 2005 Evacuation of New Orleans Area Preparedness --- or lack of.. Some did not leave.. Why dont people leave?? Experiences: Dont see danger or been through other bad storms Dont believe officials: Cry wolf No money to travel (end of month) Too much traffic Wont leave pets No transportation (20% without vehicles) Of those who stayed. More likely to be: In Poverty: no transportation or no money Elderly: experience with hurricanes; not up to traveling Sick and disabled: too ill to travel risk of moving vs danger New Orleans Survived the Storm But not the Levee Failures Hurricane Katrina and New Orleans September 2, 2005 Rescue Human Tragedy 80% of the city flooded Poverty and Evacuation 27% of New Orleans below poverty level Those in poverty less likely to evacuate Sought refuge in Superdome Evacuated and dispersed across the county Houston took refugees Evacuees in Houston Astrodome 14% physically disabled 22% physically unable to evacuate 23% stayed to care for someone 25% had a chronic disease Cardiovascular disease Diabetes High blood pressure Mortality Death toll (La): > 1464 people 853 Bodies recovered in LA 480 Died in other states (8/29/05 to 10/1/05) Race: 53% African/American 40% White 2% other 5% unknown Age years: 23% 75+ years: 45 % Mortality: Emergency Phase ~ 584 Elderly died during emergency phase Elderly died in homes before rescue Heat stress in attics Cardiovascular events Nursing Homes 215 died in nursing homes Nursing Homes and Long Term Care 280 Nursing Homes 78% did not evacuate: Lack of planning Transportation issues Cost/ no reimbursement Few places to take residents Serious illnesses and chronic diseases Risk of travel vs danger Hospitals 22 hospitals 12,000 patients 24,000 staff and families Released non-critical patients Planned short term sustainability Generators and Emergency supplies Issues in palliative care Longer Term and Mortality In 6 months following Katrina Increased deaths in elderly Mental and physical stress Stress of evacuation + chronic illnesses Loss of homes and resources; Not able to rebuild Loss of independence: must live with others New Environment and loss of social networks He died of a broken heart Lessons Learned Emergency Response and Evacuation Need for organized plan for people with no transportation and special transport needs Shelters and places for people to go Allow pets in shelters Plan for hospital evacuation or support during disasters When to evacuate Plan for nursing home evacuation Family and friends plan for evacuation of elderly and disabled Still Learning Lessons Recovery Phase: Long term displacement Issues Poor more likely to be displaced Elderly and seriously ill more likely to die during disaster and evacuation Lack of health care Loss of physicians, clinics and hospitals Housing Low and moderate priced housing needs We survived Come on down