Responsibility for Disaster Plans and Pre-Event Evacuation

Responsibility for Disaster Plans and Pre-Event Evacuation concerns the duties that arise before a storm arrives: to identify foreseeable risks, arrange workable transportation, protect essential systems, and plan for the patients who cannot simply leave on their own. In the account of Hurricane Katrina, the central failure is not a single decision made in the flood. It is the accumulation of warnings, resource gaps, and institutional choices that left vulnerable people with fewer safe options as time ran out.

The scope of preparation

Preparation is presented as more than the existence of a written emergency plan. A plan must account for who will need help, what resources will move them, and whether the infrastructure supporting their care can withstand the hazard. The book repeatedly connects the disaster’s outcome to practical capacities: vehicles and drivers, backup power and water, communications between agencies, and arrangements made early enough to avoid sending critically ill people into impassable roads.

The distinction matters because a formal evacuation order does not create the means to evacuate. Nor does keeping a hospital open guarantee that patients inside it can be cared for safely. The responsibility at issue therefore extends across public officials, health facilities, corporate owners, and emergency responders, while remaining attentive to the unequal choices available to patients, staff, and residents who lack transportation or depend on continuous medical treatment.

The evacuation order and its limits

At about ten in the morning, New Orleans mayor Ray Nagin ordered an immediate mandatory evacuation. He later acknowledged that the order had been delayed while officials worked through logistical and legal questions. By then, many residents had no car or other way to leave, while those who could drive were already caught in traffic. Officials knew the city’s transportation plans had serious gaps, including too few drivers.

The New Orleans Superdome was designated as a shelter of last resort, and shuttle buses were meant to bring people there. Nagin specifically urged people with medical conditions, including those requiring dialysis, to go quickly, but the appeal did not explain what medical support they could expect at the shelter. Hospitals and their employees, meanwhile, were exempted from the order because officials feared that injured people might be turned away if hospitals closed. The exception kept hospitals operating, but it also left patients and staff inside facilities exposed to the storm’s consequences.

The transportation shortfall became tangible as calls overwhelmed Acadian, the region’s largest ambulance company. Many of the roughly two dozen ambulances made available were stuck on the interstate; some began taking patients to the Superdome rather than attempting to drive out of town. At Chalmette Medical Center, ambulances carried out the first group of critically ill patients but did not return. These were not simply failures of individual resolve: people who required transport depended on vehicles, drivers, and routes that the emergency response could not reliably provide.

Memorial’s known vulnerabilities

Memorial Medical Center’s exposure was examined before Katrina. After Hurricane Ivan’s near miss, plant operations director Eric Yancovich studied storm-surge models and assessed the hospital’s elevations. His handwritten calculations showed that less than four feet of flooding on Magnolia Street could send water over the loading dock and into the building. Although the backup generators were on the second floor, important parts of the emergency-power distribution system were below ground or only a short distance above it.

Yancovich warned his supervisor that relatively little water could disable most of the medical center. He expected that the main hospital might lose power and that patients would need to be moved to the newer Clara Wing, where he believed the electrical circuitry was better protected. The hospital had installed some flood protections, including floodgates and a raised vent for underground diesel tanks, but other recommended work was left undone. Raising emergency-power transfer switches and pumps supplying medical air and vacuum suction would have cost more than a quarter of a million dollars in the partial bid; citing insufficient capital, Yancovich kept the proposal on file for future consideration.

The eventual generator failure revealed why the location of the generators alone was not enough. They had been running for two days, although hospital disaster plans called for them to support the facility for at least three. The generators were not built for prolonged operation, and the on-site maintenance staff were not generator mechanics. As equipment failed, workers tried to restore power and connect electrical loads while water covered the basement floor. About a third of the automatic transfer switches were at a low level and appeared to be submerged. After two hours of attempted repairs and adjustments, the last backup generator surged and died at about two in the morning on August 31, nearly forty-eight hours after Katrina made landfall near New Orleans. A known vulnerability in the power system had become an immediate limit on the hospital’s ability to provide care.

Accountability and contrasting preparations

As investigators examined deaths at hospitals and nursing homes, the book frames the questions broadly: whether they were the consequences of the storm, chaotic government response, and deficient flood protection, or whether lax oversight, cost concerns, inadequate investment, or unprepared leadership also contributed. The Louisiana Medicaid Fraud Control Unit requested Memorial’s list of deceased patients and its disaster plan. If the facility could show that the plan had been followed, investigators might close the case and direct attention elsewhere. But the city’s pre-storm order had required hospitals to remain open and staffed, complicating any simple division between facility responsibility and government direction.

The comparison with Tulane Hospital shows that hazardous conditions did not dictate a single response. Tulane was also without power, hot, and surrounded by water, but its parent corporation, HCA, had arranged private helicopters and buses for patients, employees, and their families, anticipating that government resources would not suffice. The evacuation was slow but orderly, and a nurse from that hospital told her family she knew of no patients who had died there. The contrast does not erase the dangers faced at either institution; it highlights how advance arrangements could change the course of evacuation when public capacity proved inadequate.

The book also connects responsibility to questions asked before, rather than during, the emergency. A public discussion of the deaths challenged hospitals’ preparedness on the grounds that a storm was foreseeable and that the duty to anticipate a crisis belongs to the period before it strikes. The account’s broader assessment lists the delayed evacuation order, insufficient buses and drivers, uncoordinated rescue efforts, jurisdictional disputes, poor communications, and inadequate backup power and water among the causes that compounded the disaster. Fear of lawlessness also disrupted rescue work: rumors magnified the perceived threat, and some first responders were instructed to leave their posts and patients.

Lessons carried into later emergencies

The question of preparation recurs in the book’s later account of disaster medicine in Port-au-Prince after the 2010 earthquake. A field hospital’s records identified a thirty-eight-year-old patient, Nathalie LeBrun, as Jane Doe 326 because staff had difficulty recording unfamiliar names. Her existing health problems had worsened after the earthquake. When the oxygen tank supporting her ran out, her blood oxygen level fell dangerously low; staff found another tank, but the supply chain remained unreliable, and an oxygen concentrator repeatedly overheated while generator fuel was scarce.

The episode does not make the circumstances in Haiti identical to those in New Orleans. It extends the same practical question: whether emergency plans and supply arrangements account for patients whose survival depends on continuous treatment, backup equipment, and functioning power. Across both crises, responsibility is measured not only by what responders do under pressure but by what institutions and officials anticipated, funded, coordinated, and made possible beforehand.