Evolving need for alternative triage management in public health emergencies: a Hurricane Katrina case study.

In many countries, traditional medical planning for disasters developed largely in response to battlefield and multiple casualty incidents, generally involving corporal injuries. The mass evacuation of a metropolitan population in the aftermath of Hurricane Katrina evolved into life-and-death triage scenarios involving thousands of patients with nontraumatic illnesses and special medical needs. Although unprecedented in the United States, triage management needs for this disaster were similar to other large-scale public health emergencies, both natural and human-generated, that occurred globally in the past half-century. The need for alternative triage-management processes similar to the methodologies of other global mass public health emergencies is illustrated through the experience of disaster medical assistance teams in the first 3 days following Katrina's landfall. The immediate establishment of disaster-specific, consensus-based, public health emergency-related triage protocols-developed with ethical and legal expertise and a renewed focus on multidimensional, multifactorial matrix decision-making processes-is strongly recommended.

Mass medical evacuation: Hurricane Katrina and nursing experiences at the New Orleans airport.

Hurricane Katrina, a category 4 storm, struck the U.S. Gulf states in late August, 2005, resulting in the most costly and second most deadly natural disaster in recent United States history. The storm and subsequent flooding due to levee failure necessitated the evacuation of 80% of the city of New Orleans' 484,674 residents. Most of the city's hospitals and other health care resources were destroyed or inoperable. The hurricane devastated many communities, stranding people in hospitals, shelters, homes, and nursing homes. Nurses and other health care providers deployed to New Orleans to provide medical assistance experienced substantial challenges in making triage and treatment decisions for patients whose numbers far exceeded supplies and personnel. This article describes the experiences and solutions of nurses and other personnel from 3 Disaster Medical Assistance Teams assigned to the New Orleans airport responsible for perhaps the most massive patient assessment, stabilization, and evacuation operation in U.S. history. As the frequency of disasters continues to rise, it is imperative that the nursing profession realize its value in the disaster arena and continually take leadership roles.