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A Flood of Problems “[An elderly woman had] literally walked in and collapsed,” said Dr. Aiena, a


family physician. “By the time I got to her, she was on the ground, pulseless, not breathing, with blood coming out of her mouth.” Dr. Aiena was acquainted with Ms. Blanton, but nobody on the team had worked together in an emergency. “Even though we had just met each other, it was as if we had run mock codes for months,” Dr. Aiena said. “I ordered compressions started and began divvy- SXQ _Z TYL] sCY_ QY XN KX +/. t sCY_ MKVV #


t >RO MYWZ\O]]SYX] aO\O PKX^K]^SM


They miraculously found an AED, which I’m pretty sure they had to dust off.” The AED advised shock, so the shock was administered. The patient started


to move. u3 ]KSN aO XOON ^Y XN YbcQOX [_SMUVc — that was another thing that we didn’t


have on hand immediately,” he said. “Believe it or not, a National Guard medic showed up out of nowhere with an oxygen tank and an ambu bag, and he started to assemble it on the spot. He started bagging her. I started talking to her, you know, ‘Deep breaths, deep breaths.’ She’s not making sense, but she’s vocalizing and getting more and more responsive.” At about that time, an ambulance arrived and took the woman away. Twenty or 30 minutes later, Dr. Aiena got a call from the emergency department: The woman was up and talking. Dr. Aiena says the incident served as a giant pick-me-up for the shelter’s medi-


cal team. u3^ aK] VSUO K RYWO \_X K^ ^RO OXN YP K LK]OLKVV QKWO v RO ]KSN u3^ \ON _] _Z


You know, team’s down, we need something, and — boom — there’s something. I was ready to work two more shifts.”


Learning from Katrina 2_\\SMKXO 5K^\SXK aRSMR YYNON WY]^ YP 8Oa 9\VOKX] SX


Lane Aiena, MD, right, works with other members of the medical team


at the Conroe shelter. Photo courtesy of Lane Aiena, MD


rate even further after natural disas- ters, Dr. Mutter says. “If they’re in poorly served areas for


WONSMKV K^^OX^SYX SX ^RO \]^ ZVKMO KXN some fraction of that is destroyed, now they’re in really underserved commu- nities,” he said. “It just got worse.” Christopher Ziebell, MD, an assis-


Z\Y`SNON X_


merous lessons in disaster response — mainly in what not to do. Slow reaction at the federal, state, and local levels was blamed in part for the storm’s high death ^YVV YP KLY_^


" 5K^\SXK KV]Y PY\MON K^ VOK]^ WSVVSYX ZOYZVO ^Y OO ^RO ,SQ


Easy — hundreds of thousands of whom never returned home. It was the largest U.S. migration since the Dust Bowl of the 1930s. +LY_^


5K^\SXK O`KM_OO] ON ^Y ^RO 2Y_]^YX K\OK 3P ^RO\O aK] K


bright spot to Harvey, it’s that — thanks to the lessons of Katrina — Houston’s shelters, hospitals, and other medical facilities were much better prepared, says Lisa Ehrlich, MD, president of the Harris County Medical Society, who was co- director of medical operations at Houston’s NRG Stadium shelter during Har- vey. Physicians at shelters screened for both physical and behavioral problems more aggressively and addressed problems more quickly, Dr. Ehrlich says. “The hospitals had an uptick in volume, obviously, but they weren’t over- whelmed like we saw in Katrina,” she said. Many low-income residents said they received better health care at the shelters than they would have otherwise, including physical checkups, dental ObKW] Z\O]M\SZ^SYX] OcO MROMU_Z] KXN QVK]]O] PY\ ^RO \]^ ^SWO SX cOK\] .\ Ehrlich says. “They’re getting good wraparound services,” she said. “They’re getting med-


ical care, they’re getting good meals. But they don’t have anywhere to go, and they’ve lost their jobs.” Unfortunately, health care services for low-income people tend to deterio-


26 TEXAS MEDICINE November 2017


tant professor of surgery and periop- erative care at The University of Tex- as at Austin Dell Medical School, says disruption of treatment is the biggest health problem tied to natural disas- ^O\] 0Y\ SX]^KXMO ^RO YYNSXQ L\SO c shut down dialysis centers across the Houston area. An even more common problem is the interruption of medi- MK^SYX \O VV] PY\ O`KM_OO] “They might have had the where- withal to grab their pill bottle, and there might have been 64 days of pills left in that pill bottle,” said Dr. Ziebell, who has helped coordinate health care for evacuees after several hurricanes. “But when you’re completely uprooted and K \OP_QOO KXN RK`SXQ ^Y XN K XOa ZVKMO to live and a new way to make money and a new support system, that 64 days goes by pretty fast. And then suddenly, cY_ XN cY_\]OVP — ‘Oh, wait a minute, I’m down to my last three pills, and I have no way to get one.’ That certainly can come up late in the game.”


“We’ve got to take care of what


we’ve got” Tom Garcia, MD, was the only car- diologist available at West Houston Medical Center during the storm. The hospital itself remained untouched by


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