The role of Public Health Nurse Leaders The role of Public Health Nurse Leaders during the Post Recovery Phase of during the Post Recovery Phase of

Hurricane KatrinaHurricane Katrina

Adriene Jones-Gill, RN, MNAdriene Jones-Gill, RN, MN

Charlotte M. Parent, RN, MHCMCharlotte M. Parent, RN, MHCM

Disclosure StatementDisclosure Statement

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

ObjectivesObjectives

• Identify and describe two new public health Identify and describe two new public health strategies developed post Hurricane Katrinastrategies developed post Hurricane Katrina

• Describe two challenges and the importance Describe two challenges and the importance of nurse leadership in public health of nurse leadership in public health emergenciesemergencies

• Describe the landscape of healthcare in New Describe the landscape of healthcare in New Orleans post recovery of Hurricane KatrinaOrleans post recovery of Hurricane Katrina

• Describe how the dispersion of populations Describe how the dispersion of populations has affected the delivery of services in New has affected the delivery of services in New Orleans since Hurricane KatrinaOrleans since Hurricane Katrina

August 29, 2005August 29, 2005

Focus of Public Health Post Focus of Public Health Post KatrinaKatrina

Immediate Focus – Post KatrinaImmediate Focus – Post Katrina– Access to Medical CareAccess to Medical Care– Safe living conditionsSafe living conditions– Citizen’s Mental HealthCitizen’s Mental Health– Staff’s Mental HealthStaff’s Mental Health

Data of NoteData of NoteINDICATORINDICATOR

PRE-KATRINAPRE-KATRINA

20052005POST KATRINAPOST KATRINA

20082008 SOURCESOURCE

All Indicators based on data from Orleans ParishAll Indicators based on data from Orleans Parish

Number of Number of Birthing HospitalsBirthing Hospitals 55 22

City of New City of New Orleans Orleans

Emergency Emergency Medical ServicesMedical Services

Number of Number of Operating City Operating City Health ClinicsHealth Clinics 1010 44

City of New City of New Orleans Health Orleans Health

DepartmentDepartment

Number of WIC Number of WIC Clinics/SitesClinics/Sites 1515 22

City of New City of New Orleans Health Orleans Health

DepartmentDepartment

Number of Number of available public available public Housing unitsHousing units 5,1465,146 2,4742,474

Housing Housing Authority of New Authority of New

OrleansOrleans

Fair Market Rent Fair Market Rent (2 BR Unit) (2 BR Unit) $676$676 $990$990

Housing Housing Authority of New Authority of New

OrleansOrleans

Mass Mass Transportation Transportation

CapabilitiesCapabilities

71,543 daily 71,543 daily riders on 62 riders on 62

routes with 368 routes with 368 busesbuses

30,868 daily 30,868 daily riders on 31 riders on 31

routes with 109 routes with 109 busesbuses

New Orleans New Orleans Regional Transit Regional Transit

AuthorityAuthority

Mental Health Mental Health Inpatient BedsInpatient Beds

507 @ 17 507 @ 17 locationslocations 225 @ 9 locations225 @ 9 locations

Department of Department of Health and Health and HospitalsHospitals

Focus of Public Health Post Focus of Public Health Post KatrinaKatrina

Intermediate Focus – Post KatrinaIntermediate Focus – Post KatrinaSafety & PreparednessSafety & Preparedness

Future evacuation efforts, organization and Future evacuation efforts, organization and planningplanning

Sheltering Sheltering

Identifying citizens with medical needs andIdentifying citizens with medical needs and

how to assisthow to assist

Three Keys to SafetyThree Keys to Safety

• Needs Medical Resource (NMR) Needs Medical Resource (NMR) Citizen Identification 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 Needs Medical Resource (NMR)(NMR)• To identify citizens in need of medical To identify citizens in need of medical

resources during an emergency and/or resources during an emergency and/or subsequent evacuation.subsequent evacuation.

• Identify the potential medical resource Identify the potential medical resource providers; medical professionals for chronic providers; medical professionals for chronic and acute disease managementand acute disease management

• Identify mental health providers for chronic Identify mental health providers for chronic and acute mental illness manifestations as and acute mental illness manifestations as well as stress of providers.well as stress of providers.

Who are the Medically Needy ?Who are the Medically Needy ?

People with health problems that can easily People with health problems that can easily deteriorate in a non-controlled environment. deteriorate in a non-controlled environment.

People with medical problems that require People with medical problems that require utilization of devices to get around.utilization of devices to get around.

Senior citizens (65 years old)Senior citizens (65 years old) Special needs children or young adultsSpecial needs children or young adults People with compromising medical conditions People with compromising medical conditions

that limit mobility.that limit mobility. Approximate number in New Orleans Approximate number in New Orleans

identified at 5,000 to 7,000 citizens.identified at 5,000 to 7,000 citizens.

How do we track?How do we track?

• Database of medically needy citizens Database of medically needy citizens updated yearlyupdated yearly

• PSA’s and information to identify new PSA’s and information to identify new citizens – 311 systemcitizens – 311 system

• Participate in community wide events Participate in community wide events to deliver the messageto deliver the message

ShelteringSheltering

• Immediate Post Katrina – no sheltering Immediate Post Katrina – no sheltering in New Orleansin New Orleans– Citizens sheltered based on criteria of Citizens sheltered based on criteria of

general population or medical needygeneral population or medical needy

• Present day – sheltering for category 1 Present day – sheltering for category 1 & 2 storms & 2 storms – General population shelters and medically General population shelters and medically

needy sheltering oversight by the Health needy sheltering oversight by the Health DepartmentDepartment

City Assisted Evacuation Plan City Assisted Evacuation Plan CAEPCAEP

• Developed Post Katrina to implement an Developed Post Katrina to implement an well planned evacuation for the citizens of well planned evacuation for the citizens of New Orleans.New Orleans.

• Developed multiple pick up points Developed multiple pick up points throughout the city.throughout the city.

• One central clearing site for all evacuees.One central clearing site for all evacuees.• Planned evacuation by plane, train and Planned evacuation by plane, train and

bus.bus.• Complete in a 72 hour window of called Complete in a 72 hour window of called

evacuation.evacuation.

New Orleans City Assisted Evacuation Plan Model TimelineJune 1, 2007

~12 hrs prior to hurricane landfall

Emergency Support Function Emergency Support Function ESF 8ESF 8

Public Health and Medical ServicesPublic Health and Medical Services•Medical EvacuationMedical Evacuation

•Pandemic FluPandemic Flu

•Medical Surge PlanningMedical Surge Planning

•Infectious Disease InvestigationsInfectious Disease Investigations

•Behavioral Health and Substance Behavioral Health and Substance AbuseAbuse

ESF Supporting FunctionsESF Supporting Functions• ESF-1ESF-1

– TransportationTransportation

• ESF-2ESF-2– CommunicationsCommunications

• ESF-3ESF-3– Public Works and Public Works and

EngineeringEngineering

• ESF-5ESF-5– Emergency ManagementEmergency Management

• ESF-6 ESF-6 – Mass Care, Housing and Mass Care, Housing and

Human ServicesHuman Services

• ESF-7 ESF-7 – Resource SupportResource Support

• ESF-10 ESF-10 – Oil Spill, Hazardous Materials Oil Spill, Hazardous Materials

and Radiologicaland Radiological

• ESF-11 ESF-11 – AgricultureAgriculture

• ESF-14 ESF-14 – Community Recovery, Community Recovery,

Mitigation, and Economic Mitigation, and Economic StabilizationStabilization

• ESF-15ESF-15– Emergency Public InformationEmergency Public Information

• ESF-16ESF-16– Military Support to Civil AffairsMilitary Support to Civil Affairs

Focus of Public Health Post Focus of Public Health Post KatrinaKatrina

Long Term Focus – the Future of New Long Term Focus – the Future of New Orleans Public HealthOrleans Public HealthAssess, Assure and Policy DevelopmentAssess, Assure and Policy Development

• Network of Community ClinicsNetwork of Community Clinics

• Partner and Leverage community assets to provide Partner and Leverage community assets to provide health needs, careful planning for best use of health needs, careful planning for best use of resourcesresources

• Re-Focus Health Department on Community Wide Re-Focus Health Department on Community Wide Health IssuesHealth Issues

• Implement Health in all Issues PoliciesImplement Health in all Issues Policies

• AccreditationAccreditation

Roles for the Public Health Roles for the Public Health NurseNurse

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

Challenges for the Public Challenges for the Public Health Nurse LeaderHealth Nurse Leader

Outside the comfort zone -- it’s ok Outside the comfort zone -- it’s ok

It’s more than medical careIt’s more than medical care

Critical thinking beyond healthcareCritical thinking beyond healthcare

Follow your instinct ---- and the dataFollow your instinct ---- and the data

Identifying Financial Resources Identifying Financial Resources

Questions?Questions?

Adreine Jones Gill, RN, MNAdreine Jones Gill, RN, MNajgill@nola.gov

Charlotte M. Parent, RN, MCHMCharlotte M. Parent, RN, MCHMcmparent@nola.gov