1 September 2005
Surviving Hurricane Katrina was only part of the battle. Now people must struggle with contaminated water, spoiled food, carbon monoxide poisoning, hazardous waste and days in the boiling heat.
The Bush administration declared a public health emergency Wednesday for the entire Gulf Coast to help prevent the spread of disease and provide medical care.
"It's pretty devastating out there," said Dr. Joseph Guarisco, chairman of the Department of Emergency Medicine at the Ochsner Clinic Foundation in New Orleans.
"We're seeing people on roofs and in attics. We have people who have no access to any type of resources," said Guarisco, whose hospital's higher location spared it flooding. "We're seeing lots of dehydration and a lot of patients with chronic medical conditions who don't have their medicines."
Guarisco said he expects to only get busier in weeks to come as floodwaters recede and the sick or injured are able to make it to health centers.
"Traditionally, cases will double within a week or two after disasters," he said. "We haven't seen a lot of the specific hurricane-related problems yet, which are going to be trauma, lacerations, that sort of thing.
"[After that] will be all the citizens coming back into the city and putting things back together and cutting off fingers, electrocuting themselves, some falls and slips -- there will be those types of injuries as people try to put lives back together."
But right now, things like clean water are officials' top concern.
"The next few days, staying hydrated is the big thing and avoiding consuming contaminated foods and water. ... If you can do that, you're probably OK for a week," said Guarisco.
"Beyond that, unless we get water and electricity going, it's going to be impossible to live here. Just impossible," Guarisco said.
"We're racing the clock in terms of illness, we're racing the clock in terms of food and water," Homeland Security Secretary Michael Chertoff said while visiting a Federal Emergency Management Agency unit on Tuesday.
"You have sewage contaminating the water supply," said Dr. Irwin Redlener, head of Columbia University's National Center for Disaster Preparedness. "You not only have the danger of the sewage itself, the need for water is one of the primary needs that must be fulfilled and people will drink dirty water, if they get thirsty enough."
Even if non-contaminated water can be found to drink, the water flooding homes and streets may pose a significant hazardous material situation.
"There's all the chemicals within the city -- from the gasoline storage facilities, storage plants, and of course coffins. We will have a large number of coffins released," explained Ivor van Heerden, director of the Center for the Study of Public Health Impacts of Hurricanes in Baton Rouge. "This all mixed together in New Orleans is what we term this 'toxic gumbo.'"
FEMA has placed all units of its National Disaster Medical System on alert and has mobilized many of them. The system consists of some 8,000 medical and support personnel from federal, state and local governments and the private sector.
The military is also sending medical help, including the Navy hospital ship USNS Comfort, which is set to depart Baltimore, Maryland, to reach the region in about seven days. Four ships from Norfolk, Virginia, are being loaded with food, soap, and medical supplies to arrive in the area in about five days.
Meanwhile, as full power to some areas is weeks away, officials are warning that the use of generators and indoor camp stoves or grills can to lead to carbon monoxide poisoning if not handled correctly. The colorless and odorless gas can build up quickly to deadly levels.
For those that unfortunately didn't make it through the hurricane or the days after, the family may have a long wait before someone can remove the body.
"We heard this horrific story today of a woman whose husband died and she sat in the tent for hours because there's nothing you can do with the body ... and just went to tell the coroner, 'I marked it and you can find the body here or there,'" said Redlener.
Part of FEMA's recently deployed units are the Disaster Mortuary Operational Response Teams, which consist of private citizens trained to recover, identify and process bodies.
But even after the physical threat passes, experts say the hurricane-hit population still has to deal with the psychological effects.
"Many people will be stressed and will require support over a long period of time and will be vulnerable to psychological problems. We know this from other disaster experiences," Redlener said.
Guarisco said he has been at his hospital in New Orleans since Saturday and many of the staff have been stranded there since Katrina arrived. Working in day and night shifts, they are able to take some breaks, but the stress is still there for them and the patients, he said.
"Cell phones are down, Internet is down. Communication is really bad. There's stress not knowing what your home looks like or how your family may be," he said. "And then the stress of just being locked in to a hospital for five days -- you just go from room to room, your sleeping quarters change all the time, you don't know night from day."
In the coming weeks, as the population begins physically to reconstruct, the need for mental reinforcement will be key, according to Redlener.
"The combination of needing the mental health support and trying to re-establish some semblance of life and access to vital services creates an extraordinarily complex rescue environment that people are trying to work through right now," he said.
"We have to bring services to people pretty fast," he added. "Or they'll see big problems."
http://edition.cnn.com/2005/HEALTH/08/31/katrina.public.health/index.html
