Objective: Hurricane Katrina struck the US Gulf Coast on August 29, 2005, causing unprecedented damage to numerous communities in Louisiana and Mississippi. Our objectives were to verify, document, and characterize Katrina-related mortality in Louisiana and help identify strategies to reduce mortality in future disasters.

Methods: We assessed Hurricane Katrina mortality data sources received in 2007, including Louisiana and out-of-state death certificates for deaths occurring from August 27 to October 31, 2005, and the Disaster Mortuary Operational Response Team's confirmed victims' database. We calculated age-, race-, and sex-specific mortality rates for Orleans, St Bernard, and Jefferson Parishes, where 95% of Katrina victims resided and conducted stratified analyses by parish of residence to compare differences between observed proportions of victim demographic characteristics and expected values based on 2000 US Census data, using Pearson chi square and Fisher exact tests.

Results: We identified 971 Katrina-related deaths in Louisiana and 15 deaths among Katrina evacuees in other states. Drowning (40%), injury and trauma (25%), and heart conditions (11%) were the major causes of death among Louisiana victims. Forty-nine percent of victims were people 75 years old and older. Fifty-three percent of victims were men; 51% were black; and 42% were white. In Orleans Parish, the mortality rate among blacks was 1.7 to 4 times higher than that among whites for all people 18 years old and older. People 75 years old and older were significantly more likely to be storm victims (P < .0001).

Conclusions: Hurricane Katrina was the deadliest hurricane to strike the US Gulf Coast since 1928. Drowning was the major cause of death and people 75 years old and older were the most affected population cohort. Future disaster preparedness efforts must focus on evacuating and caring for vulnerable populations, including those in hospitals, long-term care facilities, and personal residences. Improving mortality reporting timeliness will enable response teams to provide appropriate interventions to these populations and to prepare and implement preventive measures before the next disaster. (Disaster Med Public Health Preparedness. 2008;2:215–223)

Background: Despite increased government and public awareness of the threat of a radiological emergency resulting from a terrorist attack or industrial accident, limited emphasis has been placed on preparing the US health care workforce for such an event. The purpose of this study was to develop and apply a rapid survey to evaluate hospital-based nurses' baseline knowledge, self-assessed clinical competence, perception of personal safety, and willingness to respond in the event of a radiological emergency.

Methods: The study was conducted in 2 phases, the first targeting nursing units likely to respond in the event of a radiological emergency and the second focusing more generally on members of the New York State Emergency Nurses Association currently employed as hospital-based nurses.

Results: Among the 668 nurses surveyed, baseline knowledge was found to be inadequate. Although baseline knowledge, clinical competence, and perception of personal safety were all positively associated with willingness to respond, perception of safety appeared to be the primary determinant. Furthermore, baseline knowledge did not appear to be strongly associated with perception of personal safety.

Conclusions: Based on these results, the investigators recommend further clinical training to enhance preparedness and a more detailed exploration of the determinants of perceived personal safety. (Disaster Med Public Health Preparedness. 2008;2:224–229)

Background: A recent Department of Defense instruction mandates country-specific assessments, identification of interventions, and development of guidance for Department of Defense to plan, train, and prepare for the provision of humanitarian assistance in stability operations. It also directs the use of outcome-based measures of effectiveness and the establishment of processes facilitating transparency of information. Whereas this would align military-led projects closer to the standards of the international aid community, how this process will be developed and implemented within the military has not yet been determined.

Methods: To begin developing an evidence-based program for military-led humanitarian aid, we conducted a qualitative gap analysis comparing information from a Web search of Department of Defense medical after-action reports, lessons learned, and expert interviews with the internationally accepted standards in humanitarian assistance impact assessment.

Results: There is a major gap in the ability of the Department of Defense to assess the impact of humanitarian assistance in stability operations compared with international development standards. Of the 1000 Department of Defense after-action reports and lessons learned reviewed, only 7 (0.7%) reports refer to, but do not discuss, impact assessment or outcome-based measures of effectiveness.

Conclusions: This investigation shows that the Department of Defense humanitarian assistance operations are, historically, recorded without documentation using quantifiable health data identifying which aid activities contributed directly to desired outcomes or favorable public opinion, and rarely are analyzed for effectiveness. As humanitarian assistance operations assume an ever greater role in US military strategy, it is imperative that we investigate useful impact assessment models to meet mission directives and, more important, to maximize coordination in a necessarily integrated and cooperative development environment. These findings provide baseline knowledge for the implementation of an evidence-based impact assessment process to validate future Department of Defense humanitarian assistance operations. (Disaster Med Public Health Preparedness. 2008;2:230–236)

The Department of Defense does not implement health-sector humanitarian assistance impact assessments to complement those of the international humanitarian aid community. This oversight fails to meet the recent Department of Defense Directive 3000.05 mandate calling for the application of measures of effectiveness. The decision by the Department of Defense to incorporate humanitarian assistance in stability operations should be supported by evidence-based impact assessments. This article proposes implementation of an impact assessment model in Department of Defense humanitarian assistance operations. The use of an impact assessment model will refocus previously identified information gaps from traditional military input-output management toward a greater emphasis on outcomes. This will help answer which humanitarian activities are successful, which are not, and why. Over time, the use of an impact assessment model will ensure that the Department of Defense and its operational units are learning as an organization while applying evidence-based lessons learned to future stability operations. Most important, the use of this model will both provide better understanding of the role that the Department of Defense has in humanitarian activities and help interpret and transfer these activities to the host nation and international aid community in a timely and efficient manner. (Disaster Med Public Health Preparedness. 2008;2:237–244)

The lack of frequent real-world opportunities to study preparedness for large-scale public health emergencies has hindered the development of an evidence base to support best practices, performance measures, standards, and other tools needed to assess and improve the nation’s multibillion dollar investment in public health preparedness. In this article, we argue that initial funding priorities for public health systems research on preparedness should focus on using engineering-style methods to identify core preparedness processes, developing novel data sources and measures based on smaller-scale proxy events, and developing performance improvement approaches to support the translation of research into practice within the wide variety of public health systems found in the nation. (Disaster Med Public Health Preparedness. 2008;2:247–250)

Background: Coordination and communication among community partners—including health departments, emergency management agencies, and hospitals—are essential for effective pandemic influenza planning and response. As the nation’s largest integrated health care system, the US Department of Veterans Affairs (VA) could be a key component of community planning.

Purpose: To identify issues relevant to VA–community pandemic influenza preparedness.

Methods: As part of a VA–community planning process, we developed and pilot-tested a series of tabletop exercises for use throughout the VA system. These included exercises for facilities, regions (Veterans Integrated Service Networks), and the VA Central Office. In each, VA and community participants, including representatives from local health care facilities and public health agencies, were presented with a 3-step scenario about an unfolding pandemic and were required to discuss issues and make decisions about how the situation would be handled. We report the lessons learned from these pilot tests.

Results: Existing communication and coordination for pandemic influenza between VA health care system representatives and local and regional emergency planners are limited. Areas identified that would benefit from better collaborative planning include response coordination, resource sharing, uneven resource distribution, surge capacity, standards of care, workforce policies, and communication with the public.

Conclusions: The VA health system and communities throughout the United States have limited understanding of one another’s plans and needs in the event of a pandemic. Proactive joint VA–community planning and coordination—including exercises, followed by deliberate actions to address the issues that arise—will likely improve pandemic influenza preparedness and will be mutually beneficial. Most of the issues identified are not unique to VA, but are applicable to all integrated care systems. (Disaster Med Public Health Preparedness. 2008;2:251–257)