"The importance of hospitals goes far beyond the role they play in saving lives after disasters. They are powerful symbols of social progress and a prerequisite for economic development, and as such, special attention must be given to reducing their physical vulnerability," said the report, "Safe Hospitals -- A Collective Responsibility, A Global Measure of Disaster Reduction," prepared by the an American Health Organization/World Health Organization for the U.N. World Conference on Disaster Reduction.

Perhaps some of the most disturbing images of last year's Hurricane Katrina were the condition of the hospitals in New Orleans.

"For any community, the main hospital or health center has a significance far beyond other critical facilities such as power plants, airports or firefighting stations," says the "Safe Hospitals" report. "The emotional repercussions of losing a hospital can lead to a loss of morale and a sense of insecurity and social instability, which have not yet been fully appraised or understood."

Few places have had as many warnings of impending natural disaster than New Orleans. While the city's hospitals had weathered Hurricane Katrina, as they had other hurricanes, the flooding created by the break in the levees left most hospitals and nursing homes without power, communications, water and sewage service, according to a report entitled "After Katrina: Hospitals in Hurricane Katrina," by the Urban Institute.

The Louisiana attorney general's office had opened criminal investigations into the deaths of hospital and nursing-home patients.

The Louisiana Hospital Association has said that 1,749 patients occupied the 11 hospitals surrounded by floodwaters, but the hospitals also housed more than 7,600 people, mostly family of healthcare personnel, plus 45 dogs and 15 cats.

Although ambulatory patients and some psychiatric patients had been evacuated before the storm, many on life-support could not be moved, and some hospitals could find no hospital to take additional patients.

"Officials at Charity Hospital said they did not consider evacuation in advance because Charity had always been where nursing homes and other facilities sent patients in major storms," the Urban Institute report said.

"There was no city or state plan for moving hundreds of patients from multiple institutions. Hospitals did have contractual arrangements for ambulance services, but one hospital official said that when he called Sunday to move 12 ventilator patients to Lake Charles, he was told that the mayor had taken control of all ambulances and that in any case, the traffic was so bad that they would not likely get back and forth before the storm hit."

Despite the repeated warnings of flooding because of New Orleans being built below sea level, most hospitals had their power-generating equipment in the basement, along with supplies, medical files, extra equipment and morgues. Most hospitals had about a week's worth of supplies, which they went through quickly because of the extra people in the hospitals.

One hospital got supplies from its corporate headquarters, only to have them confiscated by FEMA; another hospital had its ambulances turned back by authorities, and one hospital said FEMA diverted a shipment of fuel needed for hospital generators, according to the Urban Institute report.

The Urban Institute report concluded that disaster planning was left to individual hospitals, though the disaster was area wide and disaster plans before Katrina implicitly assumed that hospitals -- and other large New Orleans' buildings -- could withstand a hurricane.

"(The hospitals') vulnerability to the secondary consequences of the storm was not anticipated either by governmental officials or by hospitals themselves," the Urban Institute report said.

"Katrina showed that hospitals depend heavily on citywide infrastructure -- electrical power, communications, water, security, and transportation -- that can be disrupted by an area wide disaster."

I think hospitals should be a safe haven for not only the sick and injured, but for their personnel and first responders during any emergency. Moving sick people is a dangerous maneuver under any conditions, and as Katrina showed, those evacuated via ambulance can get stuck in evacuation gridlock.

After the August 2003 blackout, it seemed to me that numerous public buildings should not only maintain their services during an emergency, but also provide a refuge for others.

Instead of depending on fuel generators, any public building could choose to install a natural-gas power generator on its roof that provides power not only during a blackout, but every day. Having dependable power -- no matter what -- seems a necessity in this day and age.

I am assured hospitals are increasingly including disaster preparedness in their new building plans, but there is no national standard for construction -- the closest are guidelines from the American Institute of Architects, which are not adopted by all states, according to the American Hospital Association.

"The issue of emergency preparedness is likewise a state by state issue; for example, California has seismic -- earthquake -- design requirements that are unique to that state," David L. Allen of the American Hospital Association told UPI's Caregiving. "Anecdotally, we have not talked to a hospital in years that has not taken disaster preparedness into account during design."

Hospitals should be a port in a storm. All too often they are not, but if a disaster or a terrorist attack occurs, at the very least they should have power and water and be able to take care of the most vulnerable.

Alex Cukan is an award-winning journalist, but she always has considered caregiving her primary job. UPI welcomes comments and questions about this column.

Next: a return to hospital infections

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