Post Hurricane Katrina

Post Hurricane Katrina/Rita

Notes for healthcare providers interested in helping

Notes Dated 26 September 2005:

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Medical Needs in Louisiana - information dated 26 September 2005

Just prior to the landing of Hurricane Rita, the emergent needs (from Katrina) have been met and the medical focus has shifted towards addressing primary care needs of displaced persons and EMS crews still working in the areas hit.

Specific areas where medical teams are being utilized are in shelters that house thousands, in community clinics that are overwhelmed by the influx of displaced persons, in camps caring for EMS workers, and at major triage centers located throughout the state.

Prior to Hurricane Rita, Louisiana was looking at a severe medical shortage for months to come. With the landing of Hurricane Rita, the health care needs have again returned to emergent/urgent care of displaced persons in the major triage centers, and it would be a fair assumption that the long term medical crisis is only going to further deteriorate with the increased populations of displaced persons and decreased number of habitable areas and usable clinics and hospitals.

Deploying individuals or a team to Louisiana is actually rather straight forward if you talk with the right folks.

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Note: As of 26 September 2005, the Governor’s executive orders to allow for out of state health care providers (physicians, PAs, RNs, LPNs, Veterinarians, etc) to practice in Louisiana has been extended through 25 October 2005. The new credentialing process takes about 10 minutes at the

EOC (Emergency Operations Center) in Baton Rouge and requires a driver's license and copy of your professional license.
2005 Louisiana Executive Orders - http://www.state.la.us/osr/other/2005KBBexo.htm

Declaration of Public Health Emergency To Suspend Out-of-State Licensure for Medical Professionals and Personnel
Executive Order No. KBB 05-26 - http://www.state.la.us/osr/other/kbb05-26.htm

Declaration of Public Health Emergency and Suspension of In-State Licensure for Medical Professionals And Personnel Licensed Out-of-State (Replaces KBB 05-26)
Executive Order No. KBB 05-33 - http://www.state.la.us/osr/other/kbb05-33.htm

Extension of Executive Order No. KBB 05-33 Declaration of Public Health Emergency and Suspension of In-State Licensure for Medical/Health Professionals and Personnel Licensed Out-of-State - Expires Tuesday, October 25, 2005
Executive Order No. KBB 05-47 - http://www.state.la.us/osr/other/kbb05-47.htm

Emergency Suspension of In-State Licensure for Veterinarians -
http://www.state.la.us/osr/other/kbb05-35.htm

Extension of Executive Order No. KBB 05-35 Emergency Suspension of In-State Licensure for Veterinarians - Expires Tuesday, October 25, 2005
http://www.state.la.us/osr/other/kbb05-43.htm

In essence - Out-of-state or out-of-country medical professionals and personnel offering services to the state of Louisiana are allowed to practice:

...in good faith and within the reasonable scope of his or her skills, training, or ability.

and

...shall thus be considered agents of the state of Louisiana for tort liability purposes contingent upon said out-of-state or out-of-country medical professional and personnel possessing a current medical license in good standing in their respective state or country of licensure and that they practice in good faith and within the reasonable scope of his or her skills, training or ability.

Since the situation is changing on a daily basis, the Louisiana Department of Public Health recommends that individual providers and groups should register and contact them prior to deploying.

The Public Health Department is trying to get volunteers connected with areas of need but are faced with many challenges. They are under staffed with volunteers and are faced with a chaotic situation where medical needs are constantly changing as large populations are shifted around, security concerns change, volunteers come and go and are faced with the threat of future hurricanes. They foresee the need for volunteers in the months to come and are trying to space out the those willing so as to conserve the available pool for the long haul.

You can register at www.helpthemnow.net. Once you register, the Public Health Department will then try to fit individuals and groups in where needed.

For those wanting to expedite things, the health department asks that you organize groups (docs, PAs, nurses, etc.) that can be deployed as a team to the affected areas. Groups can be better utilized and are easier to manage than deploying many individuals.

Groups and individuals can also setup their own missions, but will still need to be licensed in the State - which takes about 10 minutes at the EOC (Emergency Operations Center) in Baton Rouge. Just bring your licenses and IDs with you.

Please note - although there is plenty of work to be done, it is not recommended that you just show up without setting something up before hand. There are several groups in Baton Rouge that were delayed in finding gainful employment due to lack of contacts.

Louisiana Department of Health and Hospitals
Register at-
www.helpthemnow.net

Physicians, PAs call-
(225) 763-5766
(225) 765-0940

Nurses Call-
(225) 763-5766

Mailing address-
ATTN: Charise Stovall
6867 Bluebonnet Blvd
Baton Rouge, LA 70810

Physical address-
Jimmy Swaggart Ministries
8919 World Ministry Ave
Baton Rouge, LA 70810

Web-
http://www.dhh.state.la.us/

EMTs need to bring their license (national registry) with them and fill out a piece of paper at the EMS office in the EOC in Baton Rouge.

The DHH is located in back of EOC at the Jimmy Swaggart Ministries building in Baton Rouge
This is the headquarters for all medical efforts in Louisiana and should be the first place you contact for information on how, when and where you can help out.

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Here are some contacts/resources:

Brian J McGrath MD, MPH
George Washington Medical University Team
Associate Dean for Graduate Medical Education and Administration
School of Medicine & Health Sciences
2300 Eye Street, NW, Suite 707
Washington, DC 20037
202 994-3737
202 994-1604 Fax
msdbjm@gwumc.edu
Prior to heading home, I met with the medical team from The George Washington University Medical Center. Since they have already put together a team and have operated in the area, they would be able to provide a great deal of information for individuals or a potential team interested in volunteering.

The Louisiana Primary Care Association
4550 North Boulevard, Suite 120
Baton Rouge, Louisiana 70806
Contact Angela Y. Sheffie - Workforce Development Coordinator
angela@lpca.net
(225) 927-7662 (ext 8#)
(225) 927-7688 Fax
They have over 40 community clinics, many of which need staffing.
They can provide lists of medical needs including staffing requirements, medical supplies, etc.

St Charles Community Health Center
843 Milling Avenue
Luling, LA 70070
Contact Linda Jordan Clinical Operations Director COO
(985) 785-5872
(504) 717-1188 cell
linda.jordan@stcchc.org
They are located 2 blocks from a church that houses health care workers with a hospital in between that has showers. Good home cooked meals are provided at the church.
Volunteers are needed now to replace those leaving.
This clinic is part of the Louisiana Primary Care Association (see above)

Jara Roux
Director United Way in St Charles
(985) 331-9063
uwsc@ix.netcom.com
She is not a health care provider, but may be able to help you get connected with a clinic or other community service that needs you, and possibly housing.

First Baptist Church
Todd and Tabatha Hallman
(985) 785-6297
921 Paul Maillard Road
PO Box 155
Luling, LA 70070
tabby@fbcluling.org
They house and feed volunteers (you won't go hungry here). Church is being used as relief center.

The Chapel
Located on the LSU campus
3355 Dalrymple Drive
Baton Rouge, LA 70802
(225) 387-4416
House medical workers in Baton Rouge.
This is a great place to network, since its full of health care providers operating in and/or moving through Baton Rouge.
Volunteer chef makes great meals and stocks the fridge
Phone and internet available
Lots of cots for sleeping
Laundry service
Shower facility behind the Chapel.

MetroCare
This company has a contract to provide EMS services in New Orleans. They will hire EMT B, I and Ps for as long as you are willing to work (even just one day).
They have a camp adjacent to the EOC in Baton Rouge and housing in New Orleans.
Shifts are 12 hours long.
Contact: Caron Wind
PO Box 22278
Beaumont, TX 77720-2278
clwind@metrocareems.com
(409) 284-7718 cell
(409) 726-9119 pager
(409) 729-0098 fax
(409) 729-0212 office
You might even get a really cool New Orleans Hurricane Relief t-shirt if your timing is right.

LSU Medical Center
Medical Professional Scheduling for Katrina/Rita evacuee aid
http://www.ccm.lsuhsc-s.edu/
User name is Katrina
Password is Katrina

US Health and Human Service
https://volunteer.ccrf.hhs.gov/
hurricanehelp@hhs.gov
They have stopped taking individual volunteers, but are still interested in taking groups of 5 or more.
As of 20 September 2005 - they have deployed 150 of the over 34 thousand volunteers.

CDC
Hurricane Disaster in the U.S.: Interim Health Recommendations for Relief Workers
http://www.cdc.gov/travel/other/hurricane/hurricane_relief_workers.htm

HIPAA Privacy Rule Compliance Guidance and Enforcement Statement For Activities in Response to Hurricane Katrina
http://www.hhs.gov/ocr/hipaa/EnforcementStatement.pdf

American Association of Physician Assistants - Summary of State Regulation of Physician Assistant Practice
http://www.aapa.org/gandp/statelaw.html
Note - The Louisiana State licensure laws, rules, and regulations for medical professionals and personnel are hereby suspended for those medical professionals and personnel from other states or other countries offering medical services in Louisiana. http://www.state.la.us/osr/other/kbb05-47.htm
In Louisiana PAs may prescribe Schedules III-V and non-controlled medications. All written entries by PAs shall be cosigned by physician within 24 hours for inpatients, acute care settings, and hospital EDs; 48 hours for nursing home patients and 72 hours in all other cases.
Being able to write prescriptions is a new thing (September 22, 2004) for PAs in Louisiana and many physicians and staff may not be aware of it.

Note - the following sites have some useful information, but may be out of date
Louisiana State Medical Society
http://www.lsms.org/

American Medical Association - Hurricane Katrina relief efforts
http://www.ama-assn.org/ama/pub/category/15474.html

Louisiana Academy of Physician Assistants
http://www.louisianapa.net/announcements.htm

American Association of Physician Assistants
http://www.aapa.org/katrina-response.html

American Academy of Nurse Practitioners
http://www.aanp.org/About+AANP/Press+Releases/The+following+are+critical+links+for+Hurricane+Katrina+relief+efforts..htm

Louisiana State Nurses Association
http://www.lsna.org/

American College of Emergency Physicians
http://www.acep.org/webportal/MemberCenter/AboutACEP/katrina/effortscontinue.htm

Texas Medical Association
http://www.texmed.org/Template.aspx?id=4301

Federation of State Medical Boards - Physician Volunteer information
http://www.fsmb.org/katrina_volunteer_info.htm

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The following notes are dated 21 September 2005 - 3 weeks post Hurricane Katrina and pre landing of hurricane Rita
Special aspects of working in post hurricane Louisiana:

The main emphasis has shifted from emergent care evacuees to basic primary care for displaced persons, relief workers, and the local community since most of the local clinics are now overwhelmed and often under staff after (health care providers were also affected by the hurricane). Any type of doctor, surgeon, PA, NP, nurse, etc can and are being utilized for primary care. The problem is connecting and housing those interested in helping with those that need help.

Louisiana still has and will continue to need health care volunteers now and in the months to come.

It's extremely hot and humid in all affected areas of Louisiana. Most health care providers are employed in air conditioned buildings, but some may be needed in outdoor settings.

Healthcare providers really should be current with their tetanus, Hep A and Hep B. They should also deploy with enough personal medications for their entire stay.

Available housing is limited or nonexistent in most areas. Volunteers should arrange for housing prior to deploying to an area and plan to sleep on cots, on the floor or even in tents.

Showers may not be available.

Dress - some volunteers at community clinics wear scrubs and white jackets, but the majority are dressed in everything from shorts and sandals to military pants and boots. Those working EMS or search and rescue should dress accordingly.

Language - many of the displaced persons don't speak English, and may not be able to read or write. There are large Vietnamese, Cambodian and French Cajon speaking populations. Many of the volunteers report having difficulties understanding the local slang.

PAs - In Louisiana PAs may prescribe Schedules III-V and non-controlled medications. All written entries by PAs shall be cosigned by physician within 24 hours for inpatients, acute care settings, and hospital EDs; 48 hours for nursing home patients and 72 hours in all other cases. Being able to write prescriptions is a new thing (September 22, 2004) for PAs in Louisiana and many physicians and staff may not be aware of it. Out-of-State and Out-of-Country PAs are allowed to provide services in good faith and within the reasonable scope of his or her skills, training, or ability and are considered agents of the state of Louisiana for tort liability purposes. http://www.state.la.us/osr/other/kbb05-47.htm

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Current Situation in Specific Areas (21 September 2005):

NEW ORLEANS -
Relief workers are housed in various buildings, nursing homes, and cruise ships. There is plenty of food and water provided for official relief workers.

NOTE- right now, you can't just show up in the city and volunteer. Volunteers must be working with a recognized group to pass thru checkpoints.

The Civic Center's parking lot continues to be used as a triage center and medevac point. The USS Iwo Jima is responsible for treatment of penetrating trauma. Other injuries are evacuated to local hospitals.

All stationary medical points are secured with armed soldiers.

Large numbers of electrical crews are slowly brining power back to the city. With the return of power, comes the increase in structural fires. Out of State fire fighters not used to the heat of Louisiana have frequently collapsed while fighting large fires.

Military, police, SWAT, fire, EMS and just about every other federal and state disaster/police organization from as far away as New York and Washington are performing operations throughout the city.

Search and rescue teams continue to find injured people and dead bodies.

Parts of the city are still flooded and blocked by debris. Most of the city looks like a ghost town, with empty streets frequented only by the occasional military or police vehicles.

The majority of traffic lights are out of service, traffic signs are missing and often upside down or twisted. Even with the very small population of emergency workers, supply trucks, media and limited business people, MVCs continue as confused people drive down the wrong side of streets and fail to stop at uncontrolled intersections.

Wet areas have a strong smell of sewage and all areas that were flooded are considered health hazards. The golf course is a big nasty sewage filled swamp.

The medical focus has shifted from mass triage and evacuation to immunizations, treatment of dehydration/heat exhaustion, and urgent/emergent care of injuries.

With the frequent occurrence of structural fires, unsafe structures, falling glass, mold, filth, bugs and lack of power, sewage and potable water, EMS is expecting a huge increase in injury and sickness if residents are allowed to return in the timeline proposed.

PLAQUEMINES PARISH
This area remains off limits. Some of the housing was completely wiped out and many of the structures that remain are still under water.

ST BERNARD PARISH
Some areas still remain flooded. Certain areas are affected by oil spills. It may take years before parts of this Parish are considered habitable.

Most of this area will remain off limits for some time.

LAFOURCHE PARISH
Some wind and water damage in area. The shrimping industry was hit hard.

AREAS ADJACENT TO NEW ORLEANS -
These areas are over saturated with displaced persons living with family, in shelters and in cars. The local health care facilities are over taxed and under staffed.

Areas recently opened to residents may not have local commercial services or may have to wait in long lines to get into major food, drug and Wal-Mart stores.

There are several shelters in these areas that need primary health care providers. All shelters are guarded/protected by armed soldiers and police.

Several hospitals in the area are trying to reopen, but are only able to with partial staffing since so many of there staff are displaced or trying to sort out their lives.

Primary medical concerns include mass immunizations, filling and writing lost prescriptions, diabetes, hypertension and urgent care. Several of the facilities in these areas can use just about any kind of health care provider for as long as they are willing to stay.

BATON ROUGE, LAFAYETTE, LAKE CHARLES AND ALEXANDRIA -
These major cities have dramatically increased their populations with displaced persons and have major shelters in place. The pharmacies are busy trying to keep up with demand.

Shelters need medical staffing and many of the first wave of volunteers are returning home.

The major triage centers, such as the one at LSU are winding down.

It may be difficult to get a rental vehicle in these areas so you should reserve them in advance and may even need to plan your air travel around it.

Curfews may still be in effect in these areas.

Many are evacuating Lake Charles in anticipation of landing of another hurricane.

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