Natural Disasters and Public Health: Hurricanes Katrina, Rita, and Wilma By Virginia M.Brennan , Editor . Baltimore : The Johns Hopkins University Press , 2009 ; 311 pp; $30.00 (softcover ).

Hurricane Katrina, in August 2005, was the costliest natural disaster in U.S. history. For most of the country, the storm was like a horrid dream that has since been forgotten, but for residents of the U.S. Gulf Coast, traumatic memories, uprooted neighborhoods, economic struggles, lingering questions about levee safety, and an increase in the number of people with poor access to health care ensure that the nightmare will continue.

Two days before the hurricane made landfall, the federal government declared a state of emergency for the U.S. Gulf Coast, yet mandatory evacuation orders were issued less than 24 hours before the storm struck. Many residents underestimated the storm’s potential, and even more had no definite plans or means for escaping the storm. What lessons can we learn from Hurricane Katrina, and how can we make certain that the U.S. Golf Coast is more prepared for the next “storm of the century”?

Natural Disasters and Public Health: Hurricanes Katrina, Rita and Wilma, a poignant book written by more than 30 authors and edited by Virginia M. Brennan, PhD, MA, is a sobering and thought-provoking look at one of the worst natural disasters in the United States. It highlights how impoverished groups suffer when their communities have no “voice in the decisions that affect their health, environment, and quality of life,” and it offers some practical solutions to help us prepare for natural disasters.

The book is divided into 26 chapters, with most chapters presented in the form of a research study or summation paper involving the many different outcomes from various agencies affected by the storms. Collectively, the papers address lessons learned when a country is short-sighted and ill-prepared to meet the demands of a natural disaster like Hurricane Katrina and “the need for comprehensive, but dynamic and flexible disaster-preparedness plan that involves all key components of society.”

Many chapters in the book, especially Chapter 9, “Hurricane Emergency Planning by Home Health Providers Serving the Poor,” by Dahlia Kirkpatrick, MD, and Marguerite Bryan, PhD, offer some insightful solutions on improving the “emergency response to impending disasters for underserved and indigent populations.” The solutions offered are not only applicable to impoverished communities and home health providers, but to any state, region, or country that is serious about preparing for natural disasters.

Having a timetable for mandatory evacuation and an evacuation plan that is comprehensive, flexible, rehearsed, and not dependant on local governmental resources is the criterion standard in preparing for a natural disaster. In addition, the plan must involve cooperation and coordination between local businesses, agencies of like-minded interests, and services in unaffected regions of the state or country. Essentially, all emergency departments should have clear and rehearsed disaster plans, as they likely will be affected to some degree by any type of crisis impacting their respective communities.

An example of a successful spontaneous evacuation involved the Chief Executive Officer (CEO) of St. Charles Parish Hospital in Luling, Louisiana. He was able to transfer all patients and close the hospital before the storm arrived, because “Desoto Hospital in Mansfield Louisiana, some 300 miles away, agreed to accept the patients.” While the CEO should be commended for a job well done, this illustrates how there could have already been a letter of agreement between both hospitals, outlining steps to follow in case either hospital faced a major disaster.

The consensus of the book is that most successful evacuations are implemented 72 hours or more before the potential disaster arrives. This ensures enough time to contact family, clients, support personnel, and accepting facilities and ample time to organize the evacuation, to avoid highway congestion, and to establish operational continuity at the destination. There are countless accounts of how limited time led to added stress and chaos and contributed to overcrowding the highways, people forgetting livesaving medicines, and having to make spur-of-the-moment life-and-death decisions during the hurricanes.

Even if the evacuation plan is implemented in a timely fashion, unforeseen problems will sabotage the best-laid plans during a natural disaster, according to Dr. Kirkpatrick and Dr. Bryan. During Hurricane Katrina, high winds toppled numerous power lines, telephone lines, and cell phone towers, and the resultant loss of communication led to added chaos. The U.S. military, the Federal Emergency Management Agency (FEMA), and first responders all have communication structures that rely on auxiliary power supply and backup radios. Hurricane Katrina could have been less of a disaster if local and state government, the military, FEMA, and first responders had all been given access to the same communication systems.

Finally, a sobering and thought-provoking look at Hurricane Katrina is presented in Chapter 2, “Katrina Perspectives on the Environment and Public Health,” written by Bailus Walker Jr., PhD, MPH and Rueben Warren, DDS, MPH, DrPH. They assert that low-income communities, like New Orleans’ Ninth Ward, are often at a major disadvantage, because of their proximity to various threats such as “hazardous landfills, incinerators, abandoned toxic waste dumps, and heavy vehicular traffic routes.” As a consequence, these communities are more likely to suffer from environmental-related health issues and public health disasters, and they need a “voice in the decisions that affect their health, environment, and quality of life.” Drs. Walker and Warren also assert that our public health infrastructure needs an infusion of innovative ideas and increased financial support if it is to address environmental problems, build ties to the mental health field, and meet the health care needs of the medically indigent, especially in this time when we are all susceptible to the next infectious pandemic, natural disaster, or terrorist attack.

In summary, Hurricanes Katrina, Rita, and Wilma combined were the storms of this century, and this book does an excellent job of outlining their effects on many components of health care. It also illustrates valuable lessons learned and provides practical solutions to help us prepare for the next major storm. This book should be required reading for everyone who is currently content with our nation’s natural disaster preparedness plans and public health infrastructure.