GAO Report: Insights for Recovering from Hurricanes Ike and Gustav and Other Recent Natural Disasters

While receiving millions of dollars in federal assistance, state and local governments bear the main responsibility for helping communities cope with the destruction left in the wake of major disasters. Now that the wind and storm surge from Hurricanes Ike and Gustav have passed and the Midwest flood waters have subsided, state and local governments face a myriad of decisions regarding the short- and long-term recovery of their communities. We have seen that actions taken shortly after a major disaster and during the early stages of the recovery process can have a significant impact on the success of a community’s long-term recovery. Accordingly, this is a critical time for communities affected by these major disasters. Insights drawn from state and local governments that have experienced previous major disasters may provide a valuable opportunity for officials to anticipate challenges and adopt appropriate strategies and approaches early on in the recovery process. There is no one right way for how state and local governments should manage recovery from a major disaster, nor is there a recipe of techniques that fits all situations. While many of the practices we describe in this report were tailored to the specific needs and conditions of a particular disaster, taken together, they can provide state and local officials with a set of tools and approaches to consider as they move forward in the process of recovering from major disasters. Drawing on experiences from six major disasters that occurred from 1989 to 2005, GAO identified the following selected insights:

• Create a clear, implementable, and timely recovery plan.
• Build state and local capacity for recovery.
• Implement strategies for businesses recovery.
• Adopt a comprehensive approach toward combating fraud, waste, and abuse.

Gustav Blog III

Secretary Mike Leavitt's Blog (Written September 3, 2008) After spending Tuesday in Texas looking at shelters, the weather and air space cleared sufficiently so that I was able to join the President in Louisiana to review the progress in dealing with Hurricane Gustav. Rather than attempt to detail the entire trip or various meetings I want to write a series of observations I made during the day. First, we are getting much better at emergency response. One example is the fact that in the 72 hours before the storm hit, the largest medical evacuation in our nation’s history took place. We relocated more than 10,000 people from nursing homes, hospitals and situations requiring special needs. We did it in an orderly, safe and well planned way. Was it perfect? No, but it was done extremely well. I’m hoping the real story of our nation’s response will not be missed. The media reports on the activities of the federal, state and local government to establish organization and facilities. However, the big story is the hundreds of thousands of Americans who previously didn’t know what to do this time ended up in shelters across the country. During Katrina there were more than 600,000 people in shelters. During this storm we had about 80,000 despite similar numbers being displaced overall. (On Wednesday there were only about 60,000 in shelters.) There were hundreds of thousands of people who developed individual and family evacuation plans and executed them. Families went to Aunt Mabel’s, friends, motels or camp grounds. Preparedness isn’t just government’s work; it is the reaction of the ordinary citizen. The aggregate of each prepared citizen played starring roles in the drama. This is very good news because government simply cannot respond to everyone, we have to create facilities for the exception, the special need, the anomaly. I report this not as way to be solicitously upbeat. The big story is that positive citizen action is key to successful execution. There were 1.5 million people who were evacuated in less than 12 hours. (During Katrina it took 25 hours for that many) Most of them took care of themselves this time allowing government to do a much better job with those that couldn’t. The big problem right now in Baton Rouge is electricity. There are 1.4 million people without power. The lack of electricity requires constant transfers out of hospitals. Just before I left, I visited Baton Rouge General. There was a line of ambulances loading patients for transfer. As I walked up and down the hall, the conditions were extremely difficult. There was no air conditioning and few lights. They had backup generators, but they were proving inadequate for the demand. A walk through a hospital during a time period like this is an important reminder of two things: how dedicated the staff is to continue working and just how sick many of those people are which makes moving them complicated. The big commodities at this point in an emergency are water, ice, MREs (meals ready to eat—military prepackage meals) and tarps.

Hurricane Gustav – Blog II

Secretary Mike Leavitt in his blog: I met Jenny in a medical shelter in Tyler, Texas. She lives in Beaumont Texas where she had just undergone back surgery. She was at home beginning her recovery when Hurricane Gustuv, approached the gulf coast. Like thousands of others Jenny called 211, a telephone service offered in her area, registering for help in case evacuation was necessary. For days before the authorities monitored Gustav, and 120 hours from the time the storm was anticipated to hit the shore they opened an emergency “playbook” developed to respond to severe storms. Nobody knew at that point what the intensity of the storm would be, but with the lapse of each hour decisions needed to be made to avoid allowing time to become the enemy. There is a hierarchy of evacuation needs. People like Jenny with complicated medical needs are high on the priority list and require emergency managers to start early. Somewhere between 48 and 72 hours from land fall, officials made the decision to begin evacuation. I landed in Texas Monday night just hours after Gustav’s dissipated Category two force winds crossed Louisiana and Texas coast lines. Early Tuesday morning we flew from Dallas to Tyler Texas. I wanted to see deployment of our Disaster Medical Assistance Teams and Federal Medical shelters first hand. That’s when Jenny and I met. As Jenny sat in a special chair that held her back in proper position to heal, she told me how rescue workers picked her up and took her to a bus. The three hour bus ride out of the storm’s reach was uncomfortable she said, but it probably saved her life. I saw hundreds of patients all of whom had a story to tell. Many seriously ill before the storm and still struggling but for the most part, deeply grateful for a bed, food and medical attention offered at the two federal medical shelters set up by the state of Texas, operated by local health workers and supplemented by federal equipment, supplies, emergency teams and, of course, money. Disaster preparedness is a local and state responsibility and the state of Texas is good at it. In Tyler, Dr. Lakey, the head of the State Health Department met me. As the storm approached, state emergency planners determined where the demands were most likely going to be felt. That’s done by simply asking the question, “If you live in an evacuation area, where are you most likely to go?” Most of the people I met on Tuesday where from Beaumont, Texas and some from western Louisiana. Given the nature of this storm, the state chooses to establish medical facilities in Tyler at a county-run community center and a few miles away at Eastern Texas Baptist College. Both the local government and the college responded with great generosity providing facilities and people. When the state feels they will not have sufficient capacity to staff and meet the demands of both the local population and the in flowing evacuees, they ask the federal government for help, specifically FEMA. My Department of Health and Human Services (HHS) is then tasked by FEMA to deploy assets we have. Those activities are managed through the Office of Assistant Secretary for Preparedness and Response and they have become very good at it. HHS provided two types of assets in this case. The first is a federal medical shelter. This is essentially a hospital in a box, more appropriately, a whole bunch of boxes. The federal medical shelter is deployed from one of our national stockpile sites and can be in place within 12 hours. We also send a component of medical workers to staff the facility. The second asset we deploy is a Disaster Medical Assistance Team (DMAT). Most states have at least one DMAT. These are remarkable people who have volunteered to be deployed with only a few hours notice anywhere they are needed. These are groups of medical professionals as well as others trained in different aspects of emergency medical needs. On Monday I saw teams from New York, Florida, New Mexico and Oregon in action. Within a few hours they establish a facility to treat the most acute patient needs. It is rather remarkable to watch. Nobody likes disaster but I must say, I am always inspired by the generosity and competence people willingly bring. They work unthinkably hard hours in beastly conditions. However, there is something about the human spirit that when people are engaged in emergency assistance they are happy and upbeat. I think there are few things more rewarding than the satisfaction that comes by providing assistance for a person in need. My mother once said to me, “Mike, we get our self esteem from the people we serve.” I believe that more than ever.

Hurricane Gustav

from Secretary Leavitt's blog The weekend has been dominated by preparation for Hurricane Gustav. Though I am now in Dallas preparing to enter the storm’s footprint with my senior team, I was working from Utah over the weekend. Assistant Secretary for Preparedness and Response, Admiral Craig Vanderwagen, operated out of our emergency management center at headquarters. He conducted briefings every few hours. The difference in the work atmosphere, by comparison to Katrina, in our department and in our interaction with other departments and states, has made the hard work of the last three years evident. Assets were moved into place, the medically compromised were evacuated (more than 9000 of them), and shelters and field hospitals were erected. HHS had more than 1,500 people deployed to the region. It has been a moment of great satisfaction to see how ably our team has functioned. Admiral Vanderwagen calmly and professionally guided the process from headquarters.