Weighing in

[Beware: this post is long and preachy]

First, it should be said that if you haven't contributed to the effort to help the people affected by Katrina, then you'd best read quietly and shut up. People unwilling to be part of the solution should avoid being part of the problem.

Now, over the last few years, I can't say I'm very fond of W. He is not the brightest man we've elected to the presidency. But I'm pretty annoyed at how he is being blamed for Katrina's aftermath. I wish to make the following 3 points.

(1) Working in health care and being inundated with courses and lectures on disaster management, I have learned one big lesson: disaster planning is local. When a hospital knows that it's gonna get fucked, it's ready to run independently (without outside power or water or help) for about 72 hours. That's because everyone who's ever run a hospital knows that it will take a minimum of 72 hours before any help may be expected.

The reasonable timetable for federal aid is usually at the week mark. The CDC and other agencies usually will take at least that long to come in force. That's reality. That's life. Big things don't just happen. And Katrina aid makes a bomb or contagious disease look like a stroll in the park.

That's why the most effective disaster planning is local. The closer you are to the problem, the quicker the response. So, local government is responsible for preparing and managing immediate disaster. And I'll give the New Orleans mayor some credit, it takes balls to call for the evacuation of a city.

But to say that the federal government and GWB are to blame for the poorly coordinated relief, that's just wrong. Sure, FEMA was stupid, but when you're handed a pile of shit, no matter how you pretty it up, it'll still be a pile of shit. State, regional, city, and even neighborhood recourses share as much blame as anyone else. Case and point, Memorial Medical Center's backup generators were in the basement. This was not the wisest move for a building that sits below sea level, in a town where most buildings don't have any basements at all.

That's just a microcosm of what I usually refer to as a cluster fuck. It's very similar to medical malpractice: one person making a mistake almost never kills someone. It takes several people making many mistakes to result in death. On a local, municipal, state, and federal level, it was one big cluster fuck of poor planning. If you think that one man could manage to do this, then you give GWB far more credit than he deserves.

(2) Let us consider that a good deal of the city of New Orleans is built below sea level and has such a horrible history of flooding that a whole system of levees and other measures to stop water had to be created by the Army Corps of Engineers. This city was destined to flood, and no matter how much you'd like to think you're safe, you cannot prevent disaster like this. You can only prepare. Nuff said.

(3) As much as I've already belittled the disaster response, there were some basic rules that were followed quite well, and it's easiest to think of it in the START model (Simple Triage And Rapid Treatment). Get rid of all the walking wounded (think Superdome folks). Get them to a safe location. Then assess those unable to leave. Medical supplies, food, all that other stuff is secondary to sorting the walking wounded from the rest. If you've done any mass casualty training, you know that the first priority, beyond anything else, is triage. Making sure that the walking wounded have food and medical supplies comes later.

Secondly, safety is paramount. Several hospitals and other locales came under gunfire. You cannot evacuate a location that is not safe for evacuation. If you've seen Black Hawk Down, you know what I mean. You cannot add more casualties to a casualty rich environment. If it wasn't safe to get folks out of hospitals and such because of gunfire and criminals, then the first priority becomes making the area safe for evacuation. I cannot find fault with putting military in the city to crack down on lawlessness, because you must make evacuation safe for evacuators. It's the medic principle. A medic is worth more than one soldier because a medic has the ability to save the lives of multiple soldiers. If you kill a medic, you can kill more than one person.

Don't get me wrong, I'm no fan of GWB, but let's get this right. Like any disaster, it begets disaster, and the common theme in all poor disaster response is that no one was in charge, or more aptly, no one was willing to take charge. Having run a few codes now, I know the value of having someone take point. The person in charge may not be the brightest or smartest or most capable, but at least someone is taking responsibility and making decisions. When no one steps up, then everyone loses. That's why nurses and respiratory therapists take ACLS training too. Someone's got to step up, and someone (anyone) is better than no one.

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