	Introduction

Hurricane Katrina struck the Gulf Coast in late August 2005, causing extensive wind damageand catastrophic flooding, and leading to Presidential disaster declarations for Alabama, Florida,Louisiana and Mississippi. The storm was one of the worst natural disasters in the nation's history. Hurricane Rita, which made landfall along the Gulf Coast in late September 2005, was somewhatless severe than Katrina when it hit. Government officials and citizens shaken by the devastation of the earlierstorm mounted aggressive preparedness efforts in anticipation of Hurricane Rita, drawing on lessonslearned from Katrina just weeks earlier. Hurricane Katrina is estimated to have killed more than 1,200 people, and displaced about2 million. The FederalEmergency Management Agency (FEMA) recently increased its estimate of the number of personsdisplaced by Hurricanes Katrina and Rita to about 2 million. Over the past decade, in response to the Oklahoma City bombing, the terror attacks of 2001and several serious natural disasters, Congress and the Administration created new authorities,structures and plans to assure that government at all levels can respond well to disasters likeHurricane Katrina. This report will discuss relevant authorities and response plans that guided the public healthand medical response to the 2005 hurricanes. This report will be updated as circumstanceswarrant. The National Response Plan

The National Response Plan (NRP) is the framework under which federal and voluntaryagencies are instructed to operate when a disaster occurs. (5) The NRP was released by DHS in December 2004, replacing theprevious Federal Response Plan. According to the NRP, which is under the overall coordination of the Secretary of HomelandSecurity, the Secretary of HHS is tasked with Emergency Support Function (ESF) #8, thecoordination of public health and medical services, as laid out in the plan's ESF#8 annex. (6) HHS is responsible forcoordinating the following activities under ESF#8, and may request assistance from 14 designatedsupport agencies and the American Red Cross as needed:
Assessment of public health and medical needs;
Health surveillance;
Medical care personnel;
Health and medical equipment and supplies;
Patient evacuation;
Patient care;
Safety and security of human drugs, biologics, and medical devices, veterinarydrugs, and other HHS-regulated products;
Blood and blood products;
Food safety and security;
Agriculture safety and security (principally with regard to food-producinganimals and animal feeds and drugs);
Worker health and safety;
All-hazard public health and medical consultation, technical assistance andsupport;
Behavioral health care;
Public health and medical information;
Vector control (e.g., control of disease-carrying insects androdents);
Potable water, wastewater and solid waste disposal;
Victim identification and mortuary services; and
Protection of animal health (principally with regard to HHS-regulated animalfeeds and drugs). Mass care is the responsibility of DHS and is carried out by FEMA and theAmerican Red Cross according to ESF#6. This system of continuous communication andcoordination is an example of the changes that have been made in national public health responsecapability in the aftermath of the September 11 and anthrax attacks of 2001, though there is stillwork to be done in assuring that all relevant state agencies have continuous EOC communicationwith those at the federal level. As discussed earlier, federal leadership for medical emergency response is based in HHS perits coordinating responsibility under NRP ESF#8. Morgues were setup in Louisiana and Mississippi to house and identify the dead. HRSA undertook a number of response efforts following Hurricane Katrina, including staffdeployments. Department of Homeland Security

National Disaster Medical System. (45) NDMS is administered by FEMA and is a partnership of HHS,DHS, the Departments of Defense and Veterans Affairs, state and local governments, and the privatesector. These after-action reports are expected to be prepared andsubmitted to a variety of agencies involved in the response to Hurricane Katrina. Disaster Planning in Healthcare

Overview. (77) 
Options for Congress. The program is in its early stages, with pilots beginning in several states,and was not ready for use in response to Hurricane Katrina.
Hurricane Katrina struck the Gulf Coast in late August 2005, causing catastrophic winddamage and flooding in several states, and a massive dislocation of victims across the country. Thestorm was one of the worst natural disasters in the nation's history. Estimates are that more than1,200 people were killed and about 2 million displaced. Hurricane Rita, which made landfall alongthe Gulf Coast in late September 2005, was ultimately less lethal than Katrina, but promptedaggressive preparedness efforts by governments and citizens shaken by the devastation of the earlierstorm.
In response to a series of disasters and terrorist attacks over the past decade, in particular theterror attacks of 2001, Congress, the Administration, state and local governments and the privatesector have made investments to improve disaster preparedness and response. New federalauthorities and programs to strengthen the nation's public health system were introduced incomprehensive legislation in 2002. Congress also created the Department of Homeland Security(DHS) in 2002 to provide national leadership for coordinated preparedness and response planning. A new National Response Plan (NRP), launched by DHS in December 2004, met its first major testin the response to Hurricane Katrina.
According to the NRP, the Department of Health and Human Services (HHS) is tasked withcoordinating the response of the public health and medical sectors following a disaster. HHS workswith several other agencies to accomplish this mission, which includes assuring the safety of food,water and environments, treating the ranks of the ill and injured, and identifying the dead. HHSactivities are coordinated with those of other lead agencies under the overall leadership of DHS.
Congress and others will review the response to Hurricanes Katrina and Rita with an eyetoward assessing how well the NRP worked as an instrument for coordinated national response, andhow well various agencies at the federal, state and local levels carried out their missions under theplan. Hurricane Katrina dealt some familiar blows in emergency response. The failure ofcommunication systems, and subsequent difficulties in coordination, challenged response efforts inthis disaster as with others before it. Hurricane Katrina also pushed some response elements, suchas surge capacity in the healthcare workforce, to their limits. The response to Hurricane Katrina hasalso called attention to the matter of disaster planning in healthcare facilities, and the potential roleof health information technology in expediting the care of displaced persons. Policymakers will nodoubt study these elements of the Katrina response and seek options for continued improvement innational disaster preparedness and response.
This report discusses the NRP and its components for public health and medical response,provides information on key response activities carried out by agencies in HHS and DHS, anddiscusses certain issues in public health and medical preparedness that have been raised by theresponse to the 2005 Gulf Coast hurricanes. This report will be updated as circumstances warrant.