Office of Minority Health, Kansas City, Missouri

Captain Edwin Galan, Region VII Coordinator, DHHS, OPHS, Office of Minority Health, Kansas City, Missouri, reflects on the ways NLM could assist in disaster management, specifically in hurricane scenarios.

Interview date: June 5th, 2007

General comments:

These answers are my non-librarian perspectives, after reflecting on “how” some of the scenarios might have been handled differently, if we’d had knowledge of possible Library (NLM) assistance and roles during these types of emergencies.

Thanks for the chance to participate.

Ed Galan

Questions:

(1.) What happened in your community (i.e., what was the disaster/emergency)?

I have participated in most major U.S. (& Caribbean) disasters over the last 15 years. Most recently, I served in a clinical provider and public health program leader role in New Orleans during the Katrina/Rita hurricanes. This involved helping convert the Baton Rouge (LSU) indoor sports arena into a temporary 250 bed acute-care hospital for displaced and injured people. We provided “triaged” medical care to thousands of patients prior to making referrals for more long-term care and assistance outside of the impacted service area.

In New Orleans, I helped as a team leader for mental health needs rendering care to all New Orleans Police & Fire Dept members (and their families) plus the EMS first responders (EMTs, Paramedics, etc…). This involved direct interface between representatives for the offices of the LA Governor, the New Orleans Mayor, and various parish (county) health leaders on mental health matters. Since most mental health services in the greater N.O. area already had severe needs pre-disaster; these were further exacerbated during and after the crisis (many which remain to this day). We were able to offer structured federal assistance via human resources and information (technical assistance) as needed to help re-create a temporary mental health services infrastructure that the local population and local providers could view as “still being their own”.

(2.) How did you respond? How do you think a librarian could have responded?

As a non-librarian provider, I attempted to direct any needs for technical assistance (TA) and resources to legitimate federal or state sources with the most accurate, relevant and practicable public health information and guidance as possible during that period. This included internet and or telephone (when restored) with sources from the CDC, NIH, SAMHSA, USPHS, etc… The intent was to offer “consistent, concise, accurate, reliable and authoritative” information on many topics (for emergencies or long term care needs). This was used to compliment any pre-existing preparedness plans at all levels of government or to establish new interventions as the needs arose and/or changed with the evolving circumstances.

Had I known of or had specific librarian information as consultants, I would have gladly used and promoted them with our overall plan for assistance and mitigation of the many issues faced. If local library communication lines are functional (internet, telephone, videoconferencing, etc.); those means or the site itself might be offered as an optional “command center” via pre-arranged MOUs/MOAs.

(3.) How have your promoted the role of medical libraries and librarians in disaster response and preparedness?

Personally, I have offered TA, ideas, suggestions and examples to NLM affiliates and associates to eventually consider for definitive collaborations with these stakeholders impacted for more effective and comprehensive planning and interventions to meet these needs. I have actively encouraged all community and government leaders nationally to include their NLM, medical and health libraries/librarians within their planning continuum, to avoid mishaps and gaps in the interventional phase of these potential scenarios. The main idea is to augment and bolster current emergency preparedness plans, by including any willing medical and health libraries/librarian partners. These partners & needs would all vary according to the geographical region that bear unique disaster requirements and/or according to the particular type of emergency incidents impacting their areas.

(4.) What, in your opinion, are the roles for libraries (and librarians) in disaster planning, response and recovery efforts?

Being ready and able to offer their constituent government and NGO offices, peer libraries, and other partners some or all of these TA resources early on in the planning stages. They must also be willing to interface and learn about the various forms of emergency & disaster planning (e.g., ICS vs. Unified Command structures), so as to minimize any disinformation or mistakes during the actual events. Also, making varied consumer/customer rapport and relationship building beforehand; (e.g., meetings, visits, work groups) to have a preexisting foundation of trust & credibility before any incident.

It is crucial perhaps at a more centralized level to have a repository of sorts that includes experiences (positive and negative), lessons learned, from valuable past emergency scenarios and how they were (or not) handled. This may help to determine where best to concentrate future enhancement efforts to offer a more essential and value added NLM contribution to the overall process.

(5.) Who, in your opinion, are potential partners for libraries wanted to get involved in disaster response?

Librarians from academia, industry and hospital corporations located in predominantly disaster prone areas and those in “safe zones” that later could offer support to those who are more severely impacted. Non-librarian partners and organizations can offer ideas as to what is of value and crucial for their operational viability, even at minimal capacity (e.g., partners’ alternative safety options, portable or electronic maps of their areas, more accurate needs assessment techniques, etc.) Partners could include “unlikely” community stakeholders: seaports, airports, either major or “sole” transit systems, nuclear power plants or similar entities. All of these could feasibly receive valuable aid on public health or medical issues from any prepared NLM affiliate. One should not exclude any potential partner from the planning & development process until a reasonable conclusion has been reached mutually.

(6.) What are some scenarios where libraries could have offered assistance?

Greater New Orleans Metro Health Task Force

U.S. Public Health Service

– MENTAL HEALTH SCENARIO –

On the A.M. of Sept 20, Mrs. ________ was noted in the ________ hospital surgical waiting room. Her daughter (______, age __ yrs) who’s had a long standing condition often misdiagnosed since birth was recently diagnosed as having an occult but misleading Patent Foramen Ovale (PFO). Over the years the daughter succumbed to strokes and other dangerous neurological conditions but recently the PFO diagnosis was determined to be the apparent main causative factor. The daughter was due to have corrective surgery immediately before the Katrina crisis but only just then was able to actually undergo the required surgical interventions for this condition.

Additionally, Mrs. ________ described the misfortunate situation where her then _____ year old son sustained a fall injury leading to his present paraplegic condition. He is now a young adult. This family is exhibiting remarkable resilience and fortitude, but serves to illustrate some of the incredible contributing factors leading to the need for continued mental health services in the greater New Orleans area. Examples like this are further exacerbated and compounded by the aftermath posed by the Katrina crisis. The potential impacts are to the patients, their families, the care providers and the recuperating health care system.

The hospital medical library was mostly intact as well as the hospital’s I.T. services enabling primary and secondary communications lines to be of a resource if needed for consultation, requests of support services (for the procedure, post operative period and for any specific family therapeutic needs). They could also be of service to nearby medical installations that also might be “ready” to resume partial or near-full services to their local populations.

Greater New Orleans Metro Health Task Force

U.S. Public Health Service

– PUBLIC HEALTH SCENARIO –

During the early stages of the Katrina disaster, the Emergency Operations Center (EOC) of ___________ Parish in LA received a confirmed report of an outbreak of chicken pox. The EOC leaders were asked about alternative measures to take in order to contain the outbreak, potential ramifications, and any approved “public information” communications to maintain calm and avoid any harmful or unnecessary actions on the public’s part. There were no immediately knowledgeable “medical” or public health personnel on site to offer accurate guidance on this (or similar matters). No prior plans for this sort of scenario were included in the EOC’s emergency preparedness planning. Solution: The first option of contacting the LA State Public Health Offices was not realistic. Reliable internet lines were used to connect with the CDC for national guidelines. A quick “cut & paste” method was used to produce a small easily printable “local EOC approved” communication card/handout for dissemination on this subject. No real forethought was given to inclusion of medical library or NLM services in this type of simple help readily available to the EOC and its communities. This type of resource could also have been expanded in a manner to widely impact many customers at the EOC or other similar entities to establish concise and accurate information on a variety of subjects.

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