Academic Public Health Community Responds to Hurricane Katrina: A Showcase of Systems and Partnership

As the calamities of Hurricane Katrina unfolded in August/September 2005, the nation’s accredited schools of public health (SPH) and their association, the Association of Schools of Public Health (ASPH), answered a call to action. Schools of public health have historically demonstrated foresight and a unified response to public health tragedies, and Hurricane Katrina has been no exception. Through effective preparation, coordination, and response, the public health academic and practice communities have joined to help address the nation’s needs in emergency preparedness and response.

In response to Hurricane Katrina:

• The Centers for Disease Control and Prevention (CDC)-funded Centers for Public Health Preparedness (CPHP) network coordinated a response to the immediate needs of their federal, state, and local practice partners,

• SPH across the country opened their doors to displaced Louisiana students, and ASPH coordinated efforts through the development of the SPH Emergency Student Placement Program.

The CPHP network, comprised of 52 centers, represents a unique partnership among accredited SPH, dentistry schools, medical schools, and veterinary schools. The mission of the CPHP network has been to provide leadership in disaster situations and to work with the public health workforce to ensure a strong public health system where and when it is needed. The strength of the CPHP network lies in its partnership with the public health practice community to provide flexible and agile response capabilities and guidance during a time of national crisis. Within hours of the Hurricane Katrina disaster, the CPHP were actively involved in coordinating response and recovery efforts.

When Hurricane Katrina hit Louisiana, Tulane School of Public Health and Tropical Medicine students were forced to leave New Orleans the same week that their fall semester was scheduled to begin. They scattered across the country to stay with family and friends, and one of their most pressing questions was how they could continue their education. ASPH leadership responded by calling upon the 36 SPH to determine how they could help these students continue their master’s and doctoral-level public health coursework.

CENTERS FOR PUBLIC HEALTH PREPAREDNESS

Comprised of the nation’s leading emergency preparedness experts, the CDC-directed CPHP network provides a mechanism for the public health practice community to access preparedness expertise before, during, and after disasters, regardless of etiology.

Starting just hours after the Hurricane Katrina disaster, this national network of centers:

• Provided training and resources to responders and volunteers;

• Deployed personnel and supplies to evacuee sites;

• Staffed operation centers and coordinated operation plans; and

• Advised federal, state, and local agencies.

A full list of the schools of public health is provided at the end of this article. While individual SPH are mentioned in this article, the authors wish to acknowledge the entire network’s efforts in preparedness and response.

CPHP provided training and resources to responders and volunteers

A number of CPHP provided just-in-time training to responders and volunteers throughout the Gulf region and at various evacuation shelters across the nation. These training sessions were given either in-person, by CD-ROM, or via the internet. Examples of training areas included infectious diseases and waterborne pathogens, incident command for physicians and crisis management, and mental health and psychosocial topics such as psychological first aid, self-care, and compassion fatigue.

In addition, two of the CPHP toolkits served as comprehensive resources on mental health issues and environmental impact. These toolkits, products of the CPHP network, provided easy references for field personnel. The CPHP network also developed a website that provided specific guidance on legal issues, including ethics and the use of volunteer health personnel. Spanish-language versions of mental health and self-care products were also made available.

CPHP deployed personnel and supplies to the afflicted Gulf region

Eight centers, located in states with existing or pending evacuee sites, coordinated with their state and local agencies to plan site activities and provide relief capacity. Activities involved at each of the sites consisted of processing incoming evacuees; conducting medical examinations; collecting and distributing medical supplies, clothing, and general supplies; enrolling volunteers; providing medical triage and care on-site; and coordinating with the American Red Cross.

In addition, experts and students of ten centers were sent to the Gulf region. Many of those deployed are recognized national disaster response experts and many have had field experience in recent war situations (e.g., the Balkans and Iraq) and other natural crises, including tsunami response in Banda Aceh, Indonesia. The network provided sanitary engineers, inspectors, environmental health experts, mental health professionals, bi-lingual health and safety professionals, and additional staff to assist state and local agencies with response and recovery efforts.

The teams that were sent to the region have been involved in assessing environmental hazards, analyzing the risks and likelihood of waterborne illnesses and flood-related injuries, performing field interviews, and evaluating the mental health impact of this disaster on the population.

Five centers are currently prepared for deployment to assist in mental health relief efforts, evaluate the psychological effects the disaster has on relief workers, offer disaster assistance to local and state health departments in the stricken area, conduct hurricane response needs assessments and hazard assessments, offer medical epidemiology support, and coordinate additional environmental health response support. Additional centers are prepared for deployment if called upon.

In addition to personnel, the CPHP network deployed possibly the largest portable civilian modular field hospital (a 210-bed mobile tent structure) and medical supplies.

CPHP staffed operation centers and coordinated operation plans

As an example of exceptional CPHP coordination and leadership, the University of Texas (UT) at Houston CPHP was called upon to orchestrate a coordinated response with federal, state, and local response authorities at the Houston, TX evacuee sites. The UT CPHP has taken the initiative in coordinating the national CPHP response in the following activities:

• Fielding calls from emergency responders

• Establishing contacts with emergency management authorities

• Activating the Student Epidemic Intelligence Service (SEIS)

• Assisting in the transfer of patients

• Serving as a specialist-identifier to assist government agencies in finding qualified experts

• Collecting data

• Providing field surveillance and general epidemiology support

• Coordinating the national CPHP response

Seven CPHP supported the UT CPHP in the national responses and have exhibited remarkable coordination in the support provided for the evacuee shelters in Houston. All of the centers provided rapid networking response and most centers were deployed in less than an hour of the request. The centers contributed to a sustained response by interchanging university faculty and staff. At this writing, the work of the CPHP continues; in the Houston Astrodome and George R. Brown Convention Center, CPHP staff are conducting rapid assessments and screenings, and collects survey data.

Students from schools of public health also provided surge capacity at the evacuation sites. For example, UT’s Student Epidemic Intelligence Service (EIS) was used at the Houston Astrodome and George R. Brown Convention Center. Several other organizations and personnel agreed to utilize these students to manage their field response activities.

The Student EIS was activated at the very beginning of the evacuee influx to Houston on September 1st. Three teams were dispatched to the Houston Astrodome under the aegis of the county health department to assist with the implementation of syndromic surveillance/screening activities using a standardized data collection form. A member of the Student EIS team was assigned as an Emergency Operations Center Director and was responsible for coordinating with two evacuee centers to support the activities of the county and city health departments. The students conducted rapid assessment activities, field surveillance, “cot surveys,” data entry, data analysis, and general epidemiology support. The Student EIS teams’ operations and responsibilities continue to expand and evolve at the time of this publication.

CPHP played an advisory role to federal, state, and local agencies

Several CPHP partnered with federal, state, and local agencies to help guide and implement emergency plans in various localities receiving Gulf region evacuees. For example, the Harvard University School of Public Health CPHP worked with state government agencies and medical societies upon receiving evacuees in the northeast region. The Harvard CPHP is also working with FEMA to examine the links between federal, state, and local decision-making and to address the National Response Plan. Harvard CPHP representatives also continue to advise the American Red Cross on the best use of its personnel and supplies by serving on the Red Cross National Advisory Committee.

SPH EMERGENCY STUDENT PLACEMENT PROGRAM

In response to the inability of Tulane University School of Public Health and Tropical Medicine to continue to operate, ASPH and schools of public health enacted a timely plan to ensure the continuation of displaced Tulane students’ education. The Emergency Student Placement Program commenced, following an unprecedented response from the 36 SPH to offer their courses and much needed assistance to these students.

ASPH facilitated the student placement process, serving as a communication hub among all the SPH. Throughout this process, ASPH worked closely with the administration of Tulane SPHTM to ensure that each of the Tulane students had an opportunity to pursue alternate academic placement for the fall 2005 semester.

ASPH coordinates student placement and communication program for Tulane students

On Friday, September 2, the leadership of ASPH convened an emergency conference call with representatives from member schools of public health to plan the placement of Tulane students. In an extraordinary move, all accredited schools agreed to host students from the Tulane School of Public Health and Tropical Medicine as “special students” for the fall semester.

On Saturday, September 3, ASPH was able to create and publicize an online student profile database to collect information on students who were in need of finding a host school. ASPH also set up a toll-free emergency student help line to assist the students in their school placements. In addition, the e-mail address studentrelief@asph.org was created to assist students in contacting ASPH. All of these communication mechanisms were staffed throughout the weekend as well as for extended weekday hours.

These services not only helped the students to communicate with ASPH regarding their school placement, but also provided them with a venue to communicate about their experiences. ASPH collected contact information, host school preference, financial aid status, visa status, areas of concentration, required course work, etc.

Based on the students’ preference, housing needs, and course needs, the student profiles were sent to the host SPH, and ASPH staff followed up via phone and e-mail with students to collect further information. Students were linked with the contact person in the host school to proceed with enrollment, often the same day that they had contacted ASPH. As a result of the student placement program, over 350 students submitted their information to ASPH and students have been placed at the majority of accredited schools of public health.

ASPH also worked with students to obtain housing near the host school for the fall semester. A number of schools were able to provide last-minute housing in the dormitories, and several faculty and students offered their homes and assistance. ASPH staff reached out to the community and identified many individuals who were willing to host a displaced student.

Since the Tulane e-mail system was inoperable for several weeks, as were many land-line and cell phones, ASPH created a listing on the ASPH website for faculty, staff, and students of Tulane to “check-in.” Over 400 faculty, staff, and students used this service to communicate with their colleagues and friends and let them know of their whereabouts and status.

Host schools welcome Tulane students

The schools of public health opened not only their doors but also their hearts to the displaced Tulane students. Several offered tuition-free opportunities, assistance, and supplies. Many host schools held special receptions and orientations for the students to become acclimated to their new environments.

While all of the SPH activities could not be collected or described in this article, the following are examples of the outstanding contributions that SPH have been offering displaced students:

• The University of Oklahoma College of Public Health assigned a “buddy” to each guest student, who helped the student with the logistics involved in attending a new school, such as enrollment, navigating the campus, library use, etc.

• The University of North Texas Health Science Center School of Public Health held a drive to collect needed supplies for their guest students.

• Some schools, such as the University of California at Berkeley School of Public Health, provided funding for students’ emergency needs.

• Alumni from the Emory University Rollins School of Public Health donated gift cards for the displaced students to use for personal needs upon their arrival at the Rollins School.

• The George Washington University School of Public Health and Health Services and the Columbia Mailman School of Public Health coordinated with faculty and students to find housing for displaced students.

• A number of schools assisted students financially by finding them assistantships or part-time jobs on campus.

The University of Texas School of Public Health (UT) was able to accommodate more than 60 students and faculty, and also provided space for Tulane administrators to regroup during the initial stages of crisis recovery.

Successes and challenges in student placements

University administrators faced numerous challenges in meeting the needs of the many last-minute enrollees. Communicating with students who were in the Louisiana area was a challenge with phone lines, e-mail, and cell phones often inoperable. International students, in particular, faced challenges because of the specific requirements to maintain their student visa status. Returning international students were required to be enrolled as full-time students and new students faced difficulties in planning their travel to the U.S.

SPH have held several conference calls and are currently addressing a number of issues unique to this situation, such as finding last-minute housing for these students, assisting them with the federal student loan process, assuring that students have access to a student health insurance plan, and providing special orientations and support systems.

CONCLUSION

Response during a crisis does not come from one organization or just from the first responders. The response to a disaster should be coordinated from all bodies of a system at all levels. The response of the schools of public health to Hurricane Katrina demonstrates this principle. As detailed in this article, ASPH and its members responded to Hurricane Katrina in two primary ways: (1) bridging academic practice linkages through the CPHP network, and (2) providing continued education for the students of the Tulane School of Public Health and Tropical Medicine. SPH and ASPH also responded in many other ways, through identifying needs and resources of CDC and other federal partners, and collaborating with associations that represent state and local health departments.

The CPHP response highlights the ability of the network to react rapidly in a time of crisis, and also exhibits the centers’ capacity to span the divide between academia and real-time response training and field expertise. In addition, it emphasizes the CPHP role in working with federal agencies and public health departments as a vital part of the public health system. Many lessons will emerge from this disaster in the areas of crisis management, incident command, mental health and psychosocial issues, risk communication, crisis leadership, field epidemiology, environmental health issues, agency communication, rural health surge capacity, sustainable response, and other topic areas.

This incident has also demonstrated the strength, compassion, and coordination of the SPH. With their guidance and response, the SPH and ASPH were able to meet emergency academic and basic living needs of the public health students displaced by this devastating hurricane. ASPH thanks all its member schools for aiding in this response effort.