Carl Schultz

Carl Schultz is a professor of emergency medicine and director of disaster medical services at the University of California at Irvine, and one of the few public critics in the book of lowering standards of care during disasters. His significance lies in challenging the premise that scarce resources make diminished care an unavoidable policy endpoint: he warns that reduced standards can relieve institutions of pressure to prepare and invest, while rigid allocation rules may cause rationing even when conditions have changed.

Professional Role and Public Criticism

Schultz speaks from a position that joins emergency medicine with disaster-service planning. The book identifies him as an unusually open critic of proposals to alter standards of care for emergencies, setting his intervention apart from a debate conducted largely through official guidance and institutional policy. He questions not only what clinicians should do when resources run short, but also what governments and health-care organizations gain when the standard itself is lowered.

His criticism focuses on the incentives behind such proposals. Lower standards, he argues, can be attractive to governments and companies because they ease the obligation to strive for better care. The danger is not confined to the moment of crisis: once a reduced standard is formally accepted, the pressure to improve disaster response may weaken, and decision-makers might be tempted to apply the same diminished expectations to non-emergency care when cost or resource constraints arise.

The Problem with Lowered Standards

The book frames Schultz’s concern against failures that were not simply sudden or unknowable. Before Hurricane Katrina, Memorial’s plant operations director, Eric Yancovich, studied storm-surge estimates and calculated that less than four feet of flooding on Magnolia Street could carry water over the loading dock. He also identified vulnerable components of the emergency power distribution system, including switches and equipment close to or below ground level. The hospital made some protective changes, but larger upgrades were deferred because of their cost.

That vulnerability became consequential when Memorial’s generators, already running for two days, failed in sequence. Engineers worked in a flooded electrical area to redirect loads, but the system continued to falter; at about two in the morning on August 31, the last backup generator died. This history gives material weight to Schultz’s objection to standards that normalize diminished care: a triage rule cannot by itself repair fragile infrastructure or undo earlier decisions not to fund protection. The book does not present Schultz as a participant in Memorial’s response; rather, his argument illuminates the wider policy problem exposed by the hospital’s breakdown.

Planning, Scarcity, and the Limits of Triage

Schultz’s position appears alongside a competing emphasis on planning. Rear Adm. Ann Knebel argues that planning helps responders reuse, reallocate, and maximize resources, making it more likely they can provide the highest standard of care circumstances allow. The disagreement is not simply between ideal care and emergency compromise. It concerns whether compromise should be treated as a settled lower standard or whether advance preparation can reduce the need for it.

The book’s broader account shows how shortages and access failures accumulated beyond any single hospital. New Orleans ordered an immediate evacuation, but residents without cars depended on public transport plans that had serious gaps, including too few drivers. Ambulances were caught in interstate traffic, and some patients were taken to the Superdome rather than out of the city. Such conditions show why triage cannot be considered apart from transport, staffing, infrastructure, and the availability of receiving care. They also reinforce Schultz’s warning that lowering the standard may conceal failures of preparation rather than solve them.

Narrative Significance

Schultz’s contribution is a challenge to treating disaster triage as the main instrument for saving lives. The book acknowledges the need to make difficult choices when demand exceeds capacity, but argues that the greater opportunity is to reduce the likelihood that such choices become necessary: limit shortages, preserve resources, and restore normal operations as quickly as possible. In this framing, triage is not a substitute for preparedness.

The timing of the Memorial patient-injection plan sharpens that point. The book notes that the plan proceeded just as helicopters began arriving in greater numbers, expanding the resources available. Schultz’s critique does not establish what any particular clinician knew or intended; instead, it helps articulate the policy stakes of decisions made under changing conditions. A disaster standard that is fixed while the situation shifts can turn temporary scarcity into an excuse for enduring reductions in care. His role is therefore less that of a character in the hospital’s immediate events than that of a public voice testing what those events should teach.