Hurricane Katrina: The Jackson Veterans Affairs Medical Center Experience

Abstract

O Sunday August 28, 2005, the National Weather Service advised that a category 5 hurricane (Katrina) would make landfall on the United States gulf coast centered at the Louisiana, Mississippi, and Alabama shorelines. That morning, the Veterans Healthcare Administration (VHA) placed key locales on disaster status, and preemptively began transferring patients to inland medical facilities. These, and the receiving institutions, mobilized resources and organized operations to prepare for both local effects of the storm and care of patients no longer able to receive medical care at centers likely to be affected by damaging winds and flooding. The need, in fact, would be much greater than anticipated as the Gulfport Veterans Affairs Medical Center (VAMC), and the military medical center at Keesler Air Force Base were obliterated by the storm and the New Orleans VAMC rendered inoperable by the levee breach. More than 100,000 veteran patients were displaced from the gulf coast areas. The G.V. (Sonny) Montgomery VAMC of Jackson, Mississippi (Jackson VAMC) is a 163-bed acute tertiary care medical center 120 miles north of the gulf coast and represented the closest large VAMC medical center to the landfall epicenter expected to escape significant direct damage from Katrina. Although still at category 1 strength when reaching Jackson, the hurricane’s effect on the hospital was largely limited to loss of electric power and water from municipal sources which did not limit its ability to function. Access to the VAs integrated electronic medical record was lost initially due to flood damage of regional servers in New Orleans. However within 1-week interfacility patient data access was restored allowing very effective care of those veterans presenting to remote sites for care. The greater Jackson metropolitan area suffered moderate damage to buildings from fallen trees and utility poles, and also widespread loss of electric power, landline and wireless communication, municipal water supplies in many areas, and (secondarily) an acute shortage of gasoline and other key commodities needed for the community. For the 8 days surrounding the hurricane landfall, the Jackson VAMC operated in disaster mode, suspending elective clinic visits, elective surgical and medical procedures, and other routine operations. Cancer care, renal dialysis, and other essential nonemergent services continued and were expanded to manage those veterans from the storm areas requiring care. The VAMC received approximately 100 evacuated inpatients from VAMCs in Biloxi and New Orleans during 3 evacuations (2 land and 1 air), self-transported patients, and unrelated individuals needing help. Inaccurate information forced the staff to prepare for possible evacuees 3–4 times this number, including ambulance groups of critical care patients which never arrived. Another 100 individuals who were not patients presented for assistance, including VAMC employees and their families, and others with no place else to turn. During the early stages of the event, when most communication mechanisms were nonfunctional and gasoline availability was extremely limited, most physicians, nurses, therapists, and pharmacists remained in-house. Once communications improved and gasoline supplies were secured, a larger percentage of health care providers were able to be available from home as needs arose. On Tuesday September 6, the Jackson VAMC resumed a normal schedule for nonemergent care delivery but continued to extend its reach to provide both local and distant patients with primary and emergency health care, pharmaceutical and medical supplies, referral specialty and subspecialty services, and other support for weeks, and in some cases months or years, after the catastrophe. The Jackson VAMC recorded no adverse events, no patient deaths, and no organizational or resource From the G.V. “Sonny” Montgomery Veterans Affairs Medical Center, Jackson, Mississippi. Submitted April 28, 2008; accepted in revised form May 14, 2008. Correspondence: Kent A. Kirchner, MD, G.V. (Sonny) Montgomery VAMC, 1500 East Woodrow Wilson Drive, Jackson, MS 39216 (E-mail: kent.kirchner@med.va.gov).