The role of Public Health Nurse Leaders during the Post Recovery Phase of Hurricane Katrina Adriene Jones-Gill, RN, MN Charlotte M. Parent, RN, MHCM

Disclosure Statement We have no financial interests or other relationship with manufacturers of commercial products, suppliers of commercial services, or commercial supporters. The presentation will not include any discussion of the unlabeled use of a product or a product under investigational use.

Objectives Identify and describe two new public health strategies developed post Hurricane Katrina Identify and describe two new public health strategies developed post Hurricane Katrina Describe two challenges and the importance of nurse leadership in public health emergencies Describe two challenges and the importance of nurse leadership in public health emergencies Describe the landscape of healthcare in New Orleans post recovery of Hurricane Katrina Describe the landscape of healthcare in New Orleans post recovery of Hurricane Katrina Describe how the dispersion of populations has affected the delivery of services in New Orleans since Hurricane Katrina Describe how the dispersion of populations has affected the delivery of services in New Orleans since Hurricane Katrina

August 29, 2005

Focus of Public Health Post Katrina Immediate Focus – Post Katrina –Access to Medical Care –Safe living conditions –Citizen’s Mental Health –Staff’s Mental Health

Data of Note INDICATORPRE-KATRINA2005 POST KATRINA 2008SOURCE All Indicators based on data from Orleans Parish Number of Birthing Hospitals 52 City of New Orleans Emergency Medical Services Number of Operating City Health Clinics 104 City of New Orleans Health Department Number of WIC Clinics/Sites 152 City of New Orleans Health Department Number of available public Housing units 5,1462,474 Housing Authority of New Orleans Fair Market Rent (2 BR Unit) $676$990 Housing Authority of New Orleans Mass Transportation Capabilities 71,543 daily riders on 62 routes with 368 buses 30,868 daily riders on 31 routes with 109 buses New Orleans Regional Transit Authority Mental Health Inpatient Beds 17 locations 9 locations Department of Health and Hospitals

Focus of Public Health Post Katrina Intermediate Focus – Post Katrina Safety & Preparedness Future evacuation efforts, organization and planning Sheltering Identifying citizens with medical needs and how to assist

Three Keys to Safety Needs Medical Resource (NMR) Citizen Identification Needs Medical Resource (NMR) Citizen Identification City Assisted Evacuation Plan (CAEP) City Assisted Evacuation Plan (CAEP) Emergency Support Function (ESF-8) Emergency Support Function (ESF-8)

Needs Medical Resource (NMR) To identify citizens in need of medical resources during an emergency and/or subsequent evacuation. To identify citizens in need of medical resources during an emergency and/or subsequent evacuation. Identify the potential medical resource providers; medical professionals for chronic and acute disease management Identify the potential medical resource providers; medical professionals for chronic and acute disease management Identify mental health providers for chronic and acute mental illness manifestations as well as stress of providers. Identify mental health providers for chronic and acute mental illness manifestations as well as stress of providers.

Who are the Medically Needy ?  People with health problems that can easily deteriorate in a non-controlled environment.  People with medical problems that require utilization of devices to get around.  Senior citizens (65 years old)  Special needs children or young adults  People with compromising medical conditions that limit mobility.  Approximate number in New Orleans identified at 5,000 to 7,000 citizens.

How do we track? Database of medically needy citizens updated yearly Database of medically needy citizens updated yearly PSA’s and information to identify new citizens – 311 system PSA’s and information to identify new citizens – 311 system Participate in community wide events to deliver the message Participate in community wide events to deliver the message

Sheltering Immediate Post Katrina – no sheltering in New Orleans Immediate Post Katrina – no sheltering in New Orleans –Citizens sheltered based on criteria of general population or medical needy Present day – sheltering for category 1 & 2 storms Present day – sheltering for category 1 & 2 storms –General population shelters and medically needy sheltering oversight by the Health Department

City Assisted Evacuation Plan CAEP Developed Post Katrina to implement an well planned evacuation for the citizens of New Orleans. Developed Post Katrina to implement an well planned evacuation for the citizens of New Orleans. Developed multiple pick up points throughout the city. Developed multiple pick up points throughout the city. One central clearing site for all evacuees. One central clearing site for all evacuees. Planned evacuation by plane, train and bus. Planned evacuation by plane, train and bus. Complete in a 72 hour window of called evacuation. Complete in a 72 hour window of called evacuation.

New Orleans City Assisted Evacuation Plan Model Timeline June 1, 2007 ~12 hrs prior to hurricane landfall

Emergency Support Function ESF 8 Public Health and Medical Services Medical Evacuation Medical Evacuation Pandemic Flu Pandemic Flu Medical Surge Planning Medical Surge Planning Infectious Disease Investigations Infectious Disease Investigations Behavioral Health and Substance Abuse Behavioral Health and Substance Abuse

ESF Supporting Functions ESF-1 ESF-1 –Transportation ESF-2 ESF-2 –Communications ESF-3 ESF-3 –Public Works and Engineering ESF-5 ESF-5 –Emergency Management ESF-6 ESF-6 –Mass Care, Housing and Human Services ESF-7 ESF-7 –Resource Support ESF-10 ESF-10 –Oil Spill, Hazardous Materials and Radiological ESF-11 ESF-11 –Agriculture ESF-14 ESF-14 –Community Recovery, Mitigation, and Economic Stabilization ESF-15 ESF-15 –Emergency Public Information ESF-16 ESF-16 –Military Support to Civil Affairs

Focus of Public Health Post Katrina Long Term Focus – the Future of New Orleans Public Health Assess, Assure and Policy Development Network of Community Clinics Network of Community Clinics Partner and Leverage community assets to provide health needs, careful planning for best use of resources Partner and Leverage community assets to provide health needs, careful planning for best use of resources Re-Focus Health Department on Community Wide Health Issues Re-Focus Health Department on Community Wide Health Issues Implement Health in all Issues Policies Implement Health in all Issues Policies Accreditation Accreditation

Roles for the Public Health Nurse Public Health Nurses are in a unique position to serve many roles: Direct health care providers – during evacuation to assess potential problems, and during re-entry for patient decompensation Emergency All Hazard Planners – sheltering needs, medically needy, evacuation needs, identify medical and social needs Educators – individual needs as well as community wide education Assessment of environment – ability to identify gaps and needs for the community for planning

Challenges for the Public Health Nurse Leader Outside the comfort zone -- it’s ok It’s more than medical care Critical thinking beyond healthcare Follow your instinct ---- and the data Identifying Financial Resources

Questions? Adreine Jones Gill, RN, MN Charlotte M. Parent, RN, MCHM