Lessons for LTC: “Five Days at Memorial”

In 2005, Hurricane Katrina devasted New Orleans—not only from the winds of the storm but from the effects on the levies which were designed to prevent the Gulf of Mexico from entering the city which was situated below sea level.

Sheri Fink’s 2013 book, Five Days at Memorial, chronicled the disaster and was recently made into a 5-part series for Apple TV+, combining dramatization of the effects on the lives of the staff, patients, and visitors to Memorial Hospital. It includes actual footage of the devastation on those living in the New Orleans in the aftermath of the storm.

There are direct implications for all long-term care (LTC) facilities on the experiences of those following the hurricane which are highlighted in the following list.

1. Despite being located below sea level, the hospital did not have a policy and procedure for hurricane evacuation or emergency measures in the event of a flood.
2. The parent company, Tenet Health, did not have policies nor did they have an effective chain of command to address the emergency in the hospital.
3. The mayor of New Orleans did not call for the evacuation of the city despite warnings about the potential impact of the storm, leaving most people without access to food, water, shelter, diapers, or first aid.
4. Even if people were warned about the need to evacuate, the city had numerous people who were too poor or who lacked the means to travel to higher ground.
5. The hospital’s generators and refrigeration were in the basement. It only took 4 feet of flooding for the power to be wiped out, the food to be spoiled, the air conditioning to fail, the elevators to stop working, and ventilators to run out of power. Sewage backed up through the hallways.
6. There was no effective chain of command for the hospital to access when the parent company sent no help. The sole source of concern came from someone in business development who was thwarted in his efforts to access Tenet resources to help Memorial.
7. The hospital used a faulty system of triage which prioritized the sickest patients rather than those who were ambulatory and most likely to survive the ordeal.
8. Volunteers were turned away from providing help as there was no one in charge of the evacuation or rescue efforts.
9. There were inadequate supplies of bottled water and canned foods to feed the patients and staff.
10. There was a lack of communication between the hospital and the city of New Orleans. Rescuers were unaware of the plight of those within the hospital.
11. There were 55 patients in a separate section of the hospital, which was leased to Life Care Centers, a long-term acute care hospital (LTACH).  There was no coordination of evacuation between the LTACH and Memorial and no assistance provided by Life Care Centers to evacuate the numerous ventilator-dependent patients, many of whom were morbidly obese and physically difficult to evacuate.

It is within our nature to avoid worst case scenarios and to believe that disasters such as Hurricane Katrina could not possibly affect our LTC facilities. This event is an opportunity for facilities to take a hard look at their disaster plans, the staff’s knowledge of how to respond, to assure that sufficient amounts of bottle water and emergency food for staff and residents is now available, to have a system of communication with emergency providers, to establish a chain of command with specific people in the corporate office, to establish and maintain a volunteer network and to be a visible member of the community. 

Many of the lessons from Hurricane Katrina are traced to the lack of disaster preparedness, yet disasters from natural events such as floods, earthquakes, droughts, wildfires, hurricanes, and tornadoes are increasing. Let us not miss the opportunity to address disaster preparedness now.