RESUMEN
OBJECTIVE: The objective of this study is to gain insight into the medical needs of disaster evacuees, through a review of experiential data collected in evacuation shelters in the days and weeks following Hurricanes Katrina and Rita in 2005, to better prepare for similar events in the future. Armed with the information and insights provided herein, it is hoped that meaningful precautions and decisive actions can be taken by individuals, families, institutions, communities, and officials should the Louisiana Gulf Coast-or any other area with well-known vulnerabilities-be faced with a future emergency. DESIGN: Demographic and clinical data that were recorded on paper documents during triage and treatment in evacuation shelters were later transcribed into a computerized database management system, with cooperation of the Department of Health Information Management at The University of Louisiana at Lafayette. Analysis of those contemporaneously collected data was undertaken later by the Louisiana Center for Health Informatics. SETTING: Evacuation shelters, Parish Health Units, and other locations including churches and community centers were the venue for ad hoc clinics in the Acadiana region of Louisiana. PATIENTS, PARTICIPANTS: The evacuee-patients-3,329 of them-whose information is reflected in the subject dataset were among two geographically distinct but similarly distressed groups: 1) evacuees from Hurricane Katrina that devastated New Orleans and other locales near Louisiana and neighboring states in late August 2005 and 2) evacuees from Hurricane Rita that devastated Southwest Louisiana and neighboring areas of Texas in September 2005. Patient data were collected by physicians, nurses, and other volunteers associated with the Operation Minnesota Lifeline (OML) deployment during the weeks following the events. INTERVENTIONS: Volunteer clinicians from OML provided triage and treatment services and documented those services as paper medical records. As the focus of the OML "mission of mercy" was entirely on direct individually specific evaluation and care, no population-based experimental hypothesis was framed nor was the effectiveness of any specific intervention researched at the time. MAIN OUTCOME MEASURE(S): This study reports experiential data collected without a particular preconceived hypothesis, because no specific outcome measures had been designed in advance. RESULTS: Data analysis revealed much about the origins and demographics of the evacuees, their hurricane-related risks and injuries, and the loss of continuity in their prior and ongoing healthcare. CONCLUSIONS: The authors believe that much can be learned from studying data collected in evacuee triage clinics, and that such insights may influence personal and official preparedness for future events. In the Katrina-Rita evacuations, only paper-based data collection mechanisms were used-and those with great inconsistency-and there was no predeployed mechanism for close-to-real-time collation of evacuee data. Deployment of simple electronic health record systems might well have allowed for a better real-time understanding of the unfolding of events, upon arrival of evacuees in shelters. Information and communication technologies have advanced since 2005, but predisaster staging and training on such technologies is still lacking.
Asunto(s)
Tormentas Ciclónicas , Planificación en Desastres , Refugio de Emergencia , Registros Médicos , Adolescente , Adulto , Anciano , Instituciones de Atención Ambulatoria , Niño , Preescolar , Documentación/normas , Servicios Médicos de Urgencia , Refugio de Emergencia/organización & administración , Femenino , Humanos , Lactante , Louisiana , Masculino , Registros Médicos/normas , Persona de Mediana Edad , Texas , TriajeRESUMEN
A "healthy communities" initiative in Louisiana led to creation of the Health Informatics Center of Acadiana(HICA) at The University of Louisiana at Lafayette, in the south central United States. Since hurricanes Katrina and Rita devastated the Louisiana coast in 2005, HICA's role has taken on heightened significance. HICA identifies vulnerable populations, documents their risk factors, and evaluates interventions intended to improve community health. HICA collaborates with the Louisiana Department of Health and Hospitals and the Lafayette Community Health Consortium (LCHC), the latter formed for coordination among local healthcare providers and agencies. Both HICA and LCHC were created when "Bonne Santé à Lafayette!"--a locally developed community health improvement plan--was implemented. This paper reports on methods and experiences of HICA and LCHC, offering these as models for addressing community concerns elsewhere. Of special interest is the discussion of Louisiana HABITS, a consumer survey methodology that HICA has developed to measure healthcare access barriers, to provide information that healthcare organizations and governments need to implement workable business strategy and public policy.
Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Política de Salud , Informática en Salud Pública , Práctica de Salud Pública , Desastres , Encuestas de Atención de la Salud/métodos , Accesibilidad a los Servicios de Salud , Investigación sobre Servicios de Salud , Humanos , Seguro de Salud/economía , Louisiana , Administración en Salud PúblicaRESUMEN
Louisiana's rural community health systems are in crisis because of pressures fueled by the rising costs of health care, sustained poor health status, state budget shortfalls and changes in priorities, and a sliding rural economy. The development of community health networks is providing new infrastructure and capacity for communities to reprioritize, formulate innovative partnerships, and leverage new resources. Successful elements of Louisiana's network development experience include community commitment to engage in study and action; the availability of capable and motivated technical assistance; an approach that involves open-engagement, community-driven decision-making; and data-driven problem definition, prioritization, and solutions. Louisiana's experiences illustrate the benefits of developing networks along with, or as a result of, a community health plan. When a community owns its health improvement plan, it is more likely to support the new network as a structure for implementation. Broad-scale participation is also a principle of success. When social service agencies are included along with health agencies, more comprehensive strategies result, and they bring additional resources, resulting in more holistic solutions. The cases of 2 networks are presented as illustrations. One involves the facilitation of a community planning process for an existing network. The plan helped to expand the network's community connections and support and provided the content for a successful application for a Health Resources and Services Administration Community Access Program grant. In the second case, a new network was developed, and it leveraged federal funds from the federal Office of Rural Health Policy's Network Development Grant Program.