The Evacuation of Older People: The Case of Hurricane Katrina
Published on: Mar 15, 2007

Evacuation of hospitals

The hospitals were explicitly exempt from the Mayor's mandatory evacuation order. A spokesman said "Hospitals don't evacuate. Hospitals stay in place." Rather they were required to have enough emergency provisions to operate for two to three days during a disaster.

Many people, however, were outside seeking refuge and they saw hospitals as tall, solid buildings. And some of these people had friends or relatives currently receiving treatment. Initially people were allowed in. As a result, there were claims that 2,000 people became trapped in the Memorial Medical Centre, a 339-bedded hospital. However, it lost power when its back-up generators failed. The elevators and the air conditioning stopped working. One local resident who had escaped there told a reporter of the "heroic" efforts of nurses to keep patients cool by wafting them with cardboard for hours.

Currently, legal action is underway concerning events on the seventh floor of the hospital. This was leased to a private company that provides long-term patient care. Escape was only possible at the first floor level, six floors below, where boats were transporting patients to helicopters. On the first floor however, the odour was 'horrendous' as a result of the stifling heat and the backed-up sewers. Moreover helicopters were scarce and the Federal Emergency Management Agency was intervening. According to the New York Times:

When private companies dispatched helicopters, trucks and buses to evacuate hospitals and nursing homes, officials from FEMA commandeered some of them for other uses ... The rescue of those who had remained in their homes, or were sheltered in an increasingly chaotic Superdome, became a priority.  
On Wednesday evening, police officers arrived at the hospital to evacuate all non-essential staff. As a result, some patients became separated from members of their families who had come to be with them. The following day, a decision was taken to abandon the hospital and to evacuate all living patients. Only the dead remained. 
The doctors and nurses were faced with few options. Conditions were deteriorating rapidly, evacuations were sporadic and security was compromised. Staff agonized whether to attempt to transport critically ill patients who might not survive the arduous evacuation. It appears another choice was considered: whether to end the lives of those who could not be moved. 

The actions of one doctor and two nurses have become another on-going legal case. Allegedly they had been engaged in acts of euthanasia. Thus the policy that hospitals should not evacuate but should be able to cope with emergencies had failed and staff were placed in an iniquitous position. There were no plans for a 'no alternative but to escape' scenario.

In summary there are six key issues in the on-going debates and legal actions associated with nursing homes and hospitals:

  • the existence and status of evacuation plans 
  • deciding whether and when to evacuate
  • the availability of transport
  • the preparation of refuges
  • the responsibilities of staff in managing an evacuation 
  • the practice of euthanasia.    

Lessons to be learnt

It is too early to draw any firm conclusions from Katrina. The available evidence however casts some light on how age is relevant to the organisation of mass evacuations and the position of older people in western societies. The most obvious point is that the media focus on race and poverty has tended to mask the issue of age.

The significance of the statistical association of physical capacity and age is confirmed. It is clear that on average older people are slower, less resilient and less inclined to escape. This is, and should be, taken into account in the planning of evacuations.

Secondly, past experience and personal biographies are relevant. The real disaster in New Orleans was not the hurricane itself, but the breaching of the levees and the subsequent flooding of large parts of the city. Had the levees not been breached then it is possible that there would have been far fewer deaths. Possibly most of the deaths of older people would have been due to the stress of evacuation, rather than the trials of sitting out the hurricane. The mistake of many was to think that Katrina was ‘just another hurricane’.

Finally, the concept of 'special needs' is a double-edged sword. Several commentators noted that the highest rates of Katrina-related deaths were among hospital patients and the residents of nursing homes.

Some might react to this by arguing that the elderly and critically ill were at the end of their lives and, when faced with such a calamitous situation, the young should come first. But as one grandson commented: "My grandmother wasn't supposed to die like this".