research paper in hurricane katrina

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Hurricane Katrina at 15: Introduction to the Special Section

All authors contributed equally to this editorial.

Hurricane Katrina was a social and public health disaster. 1 From the perspectives of health care systems, the environment, community health, and everything in between, Katrina devastated New Orleans, Louisiana, and the Gulf Coast. In the 15 years since the storm, we have learned much about how devastating natural disasters can be for a community and how many ways public health can be involved in creating opportunities for recovery and preparing for the next disaster. Some of the lessons that we learned and that we need to learn are touched on in this special section.

Hurricane Katrina devastated the public health and health care systems across the US Gulf Coast and exposed the health and racial inequities that have persisted among this community for decades. As Kim-Farley notes (p. 1448), we are reaping what we sow. Individuals and families were affected emotionally, physically, and spiritually because of this disaster. Hurricane Katrina exacerbated the community’s health problems and exposed the fragmentation in care. Despite this, individuals in the community came together to mobilize and organize and to identify solutions to transform how health care was delivered to the community while ensuring health and racial equity. Over time, social norms evolved—shifting from residents accessing care in emergency departments to residents going to community-based health care provider organizations that offered comprehensive and holistic health and wellness services, including mental health and substance abuse disorder treatment.

HEALTH AND HEALTH CARE SYSTEMS

Three contributions to this special section discuss the impact of Hurricane Katrina on individuals’ health and on health care systems. “Hurricane Katrina beat us. We lost the ability to communicate, transport by land and air, and provide health care for the population,” writes Honoré (p. 1463). In this piece, Honoré highlights the inequities that were exposed and lessons from his experience as the commander of Joint Task Force—Katrina. Honoré provides a timely invitation to readers to confront injustices and improve preparedness and response to natural disasters amid COVID-19.

Harville et al. (p. 1466) explore the trends in pregnancy outcomes in women residing in the US Gulf States after Hurricane Katrina and consider whether women had an increase in adverse pregnancy outcomes because of the disaster. Katrina put a spotlight on the need for a major transformation of public health and health care system infrastructure to support the holistic needs of individuals.

Davis et al. (p. 1472) discuss the $100 million federal Primary Care Access and Stabilization Grant program, which paved the way for innovative and sustained public health and health care transformation across Greater New Orleans. This infrastructure offered community residents easily accessible, higher quality holistic care and acted as a catalyst for sustained funding for community-based health care organizations.

ENVIRONMENTAL HEALTH

Four contributions to this special section address the environmental health issues raised and affected by Katrina. Hurricane Katrina was a natural event that had disastrous results because of the storm itself and the infrastructure and human failings that led to widespread flooding and power outages. Some of the failings were owing to being unprepared for a natural event of this magnitude. Wilson et al. (p. 1476) argue that we are still unprepared and that there remains work to be done to integrate environmental and public health expertise into a preparedness system. The 2019 Pandemic and All-Hazards Preparedness and Advancing Innovation Act is a recent policy-level action to raise environmental health preparedness. Of course, the outcome of this act will depend on our ability to implement its provisions and address any challenges.

Even when we are prepared for environmental events, the responses are not always quick enough to address the most serious concerns or to understand the full nature of the events. Lichtveld and Birnbaum (p. 1478) comment that we often focus our attention and resources on the immediate response phase and devote insufficient attention to any prolonged recovery. The longer-term problems brought on by Katrina made the environmental health community aware of and responsive to assessment and recovery after the Deepwater Horizon disaster (2010). Having the National Institutes of Health’s Disaster Research Response Program in place may facilitate immediate and longer term responses to future disasters.

Many authors have examined Katrina’s major environmental effects on New Orleans and their endurance. Diaz et al. (p. 1480) review this extensive literature and provide a summary of work related to floods, wastes, land losses, and other environmental consequences of Katrina. The numbers are staggering: 400 billion gallons of floodwaters, 120 million cubic yards of storm debris, and six times the usual annual land loss. Katrina led to the design and construction of the Hurricane Storm Damage Risk Reduction System, which we hope will help to protect New Orleans, at least in the near term.

In addition to the loss of homes and land, Katrina compromised the interiors of thousands of homes. Lichtveld et al. (p. 1485) comment on the mold infestation of homes and the resulting exacerbations of childhood asthma. Community-based participatory research addresses environmental asthma in a manner that can serve as a model for other communities. This model is particularly relevant today, as we come to grips with the full understanding of environmental health threats, disasters, and health disparities.

PUBLIC HEALTH RESPONSE

Hurricane Katrina, coined “the worst natural disaster of the century,” exposed the essential need for a multifaceted cross-sector public health response. This disaster featured a lack of city, state, and federal coordination. According to the Centers for Disease Control and Prevention, approximately 1800 people from Louisiana, Mississippi, Florida, Alabama, and Georgia lost their lives in Hurricane Katrina. 2 Five contributions to this special section look at promising community health practices that encourage predisaster planning and cross-sector coordination. In true Louisiana form, these contributions are a bit of a gumbo, looking at a variety of topics that affected community health, including public safety, cascading events, food access inequity, and community health workers as well as promising practices in pet evacuation and public health infrastructure.

Murphy et al. (p. 1490) examine the need for public health to integrate with public safety in predisaster planning as opposed to the commonplace postdisaster preparedness strategies. Murphy et al. note that lessons from Hurricane Katrina are vital for creating “a pathway to improve proactive cross-disciplinary integration and all-hazards preparedness.” (p1490) There remains a need to learn from the gaps impeding an integrated response, the federal evaluation of the Department of Homeland Security and Exercise and Evaluation Program, and the local response from the New Orleans City Assisted Evacuation framework.

Greenberg (p. 1493) urges hazard mitigation planning that includes cascading effects as a way to think beyond the natural disaster into certain “trigger events,” which can lead to deadly consequences. Greenberg highlights the need to systematically analyze how a single disaster event can cascade into multiple failures that substantially multiply severe consequences. Including cascading effects is another tool for coordinating public health and emergency response. Greenberg also looks at existing policy to coordinate these efforts through the Stafford Act.

Food access inequities were vastly expanded after Katrina. Rose and O’Malley (p. 1495) compare national programs and their food access approach, along with giving a historical perspective of programming to address the spectrum of food access issues in US metropolitan areas. Food Access 3.0 offers community-driven and socially innovative solutions to the decades-long issue of sustainable and healthy food access for families.

Haywood et al. (p. 1498) provide an account of responding to community needs and organization around community health workers during post-Katrina recovery. In the varied history of the use and acceptance of community health workers in the United States, Wennerstrom et al. describe how this necessary brigade of community liaisons organized to fill a devastating public health void in New Orleans. They state that community health workers “not only supported recovery from the devastation but also learned important lessons through organizing themselves into a professional association to support their growing workforce and influence policy.” (p1498)

Hurricane Katrina had a lasting impact on many policies in emergency preparedness and disaster response for pet safety. Babcock and Smith (p. 1500) review the critical work of disaster planning and pet safety and the lasting aftermath that changed public health policy and disaster response after Katrina. The Pets Evacuation and Transportation Standards Act of 2006, one of the early wins from dismal outcomes in New Orleans, was established with lessons learned following Hurricanes Gustav and Harvey. The need to train city, public health, and community members is key in any preparedness plan. New Orleans has shown innovation in offering training, both live and virtual, to prepare for future events.

Just as health and environmental systems have learned and evolved, so too has the public health system. As Gee (p. 1502) notes, the data systems and other critical public health infrastructure developed after Katrina have enabled more effective responses to the Baton Rouge floods and now COVID-19 than would have previously been possible. With each storm, public health systems improve to address the next one.

CONFLICTS OF INTEREST

The authors have no conflicts of interest to declare.

See also Kim-Farley, p. 1448 , and the AJPH Hurricane Katrina 15 Years After section, pp. 1460 – 1503 .

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Hurricane Katrina: an American tragedy

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Tee L. Guidotti, Hurricane Katrina: an American tragedy, Occupational Medicine , Volume 56, Issue 4, June 2006, Pages 222–224, https://doi.org/10.1093/occmed/kqj043

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The true extent of the American tragedy that is Hurricane Katrina is still unfolding almost 12 months after the event and its implications may be far more reaching. Hurricane Katrina, which briefly became a Category 5 hurricane in the Gulf of Mexico, began as a storm in the western Atlantic. Katrina made landfall on Monday, 29 August 2005 at 6.30 p.m. in Florida as a Category 1 hurricane, turned north, gained strength and made landfall again at 7.10 a.m. in southeast Louisiana as a Category 4 hurricane and rapidly attenuated over land to a Category 3 hurricane. New Orleans is below sea level as a consequence of subsidence and because of elevation of the Mississippi river due to altered flow. The storm brought a nearly 4 m storm surge east of the eye, where the winds blew south to the south shore of Lake Pontchartrain, and gusts of 344 km/h at the storm's peak at ∼1.00 p.m. Levees protecting the city from adjacent Lake Pontchartrain failed, inundating 80% of the city to a depth of up to 8 m. Further east in the Gulf Coast, a storm surge of 10.4 m was recorded at Bay St Louis, Mississippi [ 1 , 2 ].

What followed was horrifying and discouraging. Poor residents and the immobilized were left stranded in squalor. Essential services failed. Heroic rescues were undertaken with wholly inadequate follow-up and resettlement [ 3 ]. Emergency response was feeble. It was only after the military intervened that the situation began, slowly, to improve. New Orleans and much of the Gulf Coast to the east is still a depleted, devitalized, largely uninhabitable wreck. Less than a month later, on 24 September, Hurricane Rita followed. A much stronger storm in magnitude, Rita caused further displacement and disruption in Texas, where evacuation measures, undertaken in near-ideal conditions, were shown to be completely inadequate.

Floods usually conceal more than they reveal. Hurricane Katrina was an exception. It revealed truths about disaster response in the United States that had been concealed. Now, months later, one may assess the response and recovery to the disaster, evaluate how the country handled the challenge and determine what lessons were, or could have been, learned.

Katrina revealed that natural disasters and public health crises are as much threats to national security as intentional assaults. An entire region that played a vital role in the American economy and a unique role in the country's culture ground to a halt. During Katrina and Rita, ∼19% of the nation's oil refining capacity and 25% of its oil producing capacity became unavailable [ 4 ]. The country temporarily lost 13% of its natural gas capacity. Together, the storms destroyed 113 offshore oil and gas platforms. The Port of New Orleans, the major cargo transportation hub of the southeast, was closed to operations. Commodities were not shipped or accessible, including, in one of those statistics that are revealing beyond their triviality, 27% of the nation's coffee beans [ 5 ]. Consequences of this magnitude are beyond the reach of conventional terrorist acts.

Katrina revealed the close interconnection between the natural environment and human health risk. The capacity of wetlands in the Gulf Region to absorb precipitation and to buffer the effects of such storms has been massively degraded in recent years by local development. This has been known for a very long time [ 6 ], but development yielded short-term economic gain while mitigation was expensive. Katrina also revealed that understanding the threat and the circumstances that enable it means nothing if no concrete preparations are taken. The disaster that struck New Orleans, specifically, was not only foreseeable but also understood to be inevitable. Emergency managers had participated in a tabletop exercise that followed essentially an identical scenario just 13 months before, called ‘Hurricane Pam’ [ 7 ]. Had their conclusions and recommendations been acted upon, the actual event may have turned out differently. Although the levees would still have failed, perhaps those responsible for safeguarding the people would not have done so.

Katrina revealed that the federal agency designed to protect all Americans was incompetent. The Federal Emergency Management Agency (FEMA) reached its peak under President Clinton, when it enjoyed Cabinet-level rank. Post 9-11 FEMA was subordinated within the Department of Homeland Security (DHS), a department highly focused on terrorism and intentional homeland threats. The wisdom of combining the two was always in doubt. The logical solution is to move FEMA out of DHS but so far there has been no political will to do so and FEMA is so reduced and depleted as an agency that it probably could not now operate at a Cabinet level even were it to have the authority [ 5 , 8 ].

Katrina revealed how large and resilient the American economy has become overall. The evidence for this is how quickly the country has returned to economic growth and business as usual, despite the destruction of a region once economically important [ 9 ]. Katrina devastated ≥223 000 km [ 2 ] of the United States, an area almost as large as Britain. Yet, with one exception, the economy of the country barely registered an effect, even on psychologically volatile indicators such as stock market indices. It is projected that Katrina, as such, will only reduce growth in GDP for the United States by about one half of 1%. Although the southeast region served by New Orleans is very large geographically, it constitutes only 1% of the total American economy [ 10 ]. The lower Mississippi region adds little of its own economic value to GDP, other than tourism and as a source of energy. The exception noted above, of course, was the price of oil, as reflected in the prices of gasoline and refined petroleum products.

Katrina revealed how marginal the Gulf Region had become to the American economy, despite the wealth that passes through it. New Orleans itself was a poor city—it probably still is, although the returning citizens obviously have sufficient resources to allow them to return—and its neighbours in Mississippi and Alabama are not rich, either. The region is economically significant mainly for tourism, transshipment of cargo, oil and gas and for redistribution of wealth (in the form of legalized gambling). Reconstruction efforts may even fuel an economic expansion in the rest of the economy, although precious little prosperity resulting from it is likely to be seen in the devastated Gulf itself anytime soon. Astonishingly, the compounded effect of the war in Iraq, the high price of crude oil and the direct effects of Hurricane Katrina did not set back growth in the American economy, although it may have kept stock market prices level to the end of 2005.

Katrina revealed the great divide that remains between people living next to one another but differing in the clustered characteristics of race, poverty, immobility and ill-health [ 11 , 12 ]. Those who lacked the resources, who could not fend for themselves, who were left behind, who happened to be sick were almost all African–American, and therefore so were the ones who died. Relatively, well off residents near the shore of Lake Pontchartrain also sustained many deaths [ 2 ]. However, the brunt of the storm was clearly borne by the poor and dispossessed. That this was not intentional does not make it any more acceptable.

Honour in this dishonourable story came from the role of rescue, medical, public health and occupational health professionals. Rescuers took personal risks to save the stranded citizens of New Orleans. Public health agencies quickly identified and documented the risks of water contamination [ 13 ], warned of risks from carbon monoxide from portable generators [ 14 ], identified dermatitis and wound infections as major health risks [ 15 ] and identified outbreaks of norovirus-induced gastroenteritis [ 16 ]. Occupational health clinics and occupational health physicians and nurses treated the injured, from wherever they came [ 17 ]. Occupational health professionals returned critical personnel to work as soon as it was possible, to hasten economic recovery and rebuilding. Occupational Safety and Health Administration professionals warned against hazards in the floodwaters and the destroyed, abandoned houses but supplies for personal protection were nowhere to be found. The American College of Occupational and Environmental Health served as a clearing-house for information and provided almost 200 participants with web-supported telephone training on Katrina-related hazards and measures to get workers back on the job safely.

It was not enough. No human effort could have been by then. But what can we, as a medical speciality, do better next time? The occupational health physician is not, as such, a specialist in emergency medicine, an expert in emergency management and incident command or a safety engineer, although many do have special expertise in these areas because of personal interest, prior training or military experience. The occupational health physician is, however, uniquely prepared to work with management and technical personnel at the plant, enterprise or corporate level. We can assist in preparing for plausible incidents, planning for an effective response, identifying resources that will be required, and advising on their deployment.

The occupational physician has critical roles to play in disaster preparedness and emergency management. Our role in disaster preparedness is distinct from those of safety engineering and risk managers. Our role in emergency management is distinct from those of emergency medicine and emergency management personnel. Our roles in both are complementary, sometimes overlapping and predicated on the value that we bring to the table as physicians familiar with facilities. We have the means to protect workers in harm's way and from the many hazards already so familiar from our daily work. Katrina demonstrates that occupational health professionals can translate experience of the ordinary to play an integral role in dealing with the extraordinary.

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Louisiana Wetlands Protection Panel. Towards a Strategic Plan: A Proposed Study. Chapter 5. Report of the Louisiana Wetlands Protection Panel. Washington, DC: US Environmental Protection Agency, EPA Report No. 230-02-87-026, April 1987 . http://yosemite.epa.gov/oar/globalwarming.nsf/UniqueKeyLookup/SHSU5BURRY/$File/louisiana_5.pdf (6 January 2006, date last accessed).

Grunwald M, Glasser SB. Brown's turf wars sapped FEMA's strength. Washington Post 2005 ; 129 : A1 ,A8.

FEMA. Hurricane Pam exercise concludes. Region 4 Press Release R6-04-93. 24 July 2004 . http://www.fema.gov/news/newsrelease.fema?id=13051 (3 January 2005, date last accessed).

Samuelson RJ. Waiting for a soft landing. Washington Post 2006 ; 167 : A17 .

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Joint Taskforce. Environmental Health Needs and Habitability Assessment: Hurricane Katrina Response. Initial Assessment. Washington, DC and Atlanta, GA: US Environmental Protection Agency and Centers for Disease Control and Prevention, 2005 .

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MMWR. Norovirus among Evacuees from Hurricane Katrina—Houston, Texas , 2005 .

McIntosh E. Occupational medicine response to Hurricane Katrina crisis. WOEMA Quarterly Newsletter (Western Occupational and Environmental Medical Association) 2005 , pp. 2, 7.

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Monica Powers 1 2 *

AM J QUALITATIVE RES, Volume 8, Issue 1, pp. 89-106

https://doi.org/10.29333/ajqr/14086

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This study explored the lived experiences of residents of the Gulf Coast in the USA during Hurricane Katrina, which made landfall in August 2005 and caused insurmountable destruction throughout the area. A heuristic process and thematic analysis were employed to draw observations and conclusions about the lived experiences of each participant and make meaning through similar thoughts, feelings, and themes that emerged in the analysis of the data. Six themes emerged: (1) fear, (2) loss, (3) anger, (4) support, (5) spirituality, and (6) resilience. The results of this study allude to the possible psychological outcomes as a result of experiencing a traumatic event and provide an outline of what the psychological experience of trauma might entail. The current research suggests that preparedness and expectation are key to resilience and that people who feel that they have power over their situation fare better than those who do not.

Keywords: mass trauma, resilience, loss, natural disaster, mental health.

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Hurricane katrina: analyzing a mega-disaster.

• Arjen Boin , Arjen Boin Department of Public Institutions and Governance, Leiden University
• Christer Brown Christer Brown European Commission
•  and  James A. Richardson James A. Richardson Public Administration Institute, Louisiana State University
• https://doi.org/10.1093/acrefore/9780190228637.013.1575
• Published online: 28 February 2020

The response to Hurricane Katrina in 2005 has been widely described as a disaster in itself. Politicians, media, academics, survivors, and the public at large have slammed the federal, state, and local response to this mega disaster. According to the critics, the response was late, ineffective, politically charged, and even influenced by racist motives. But is this criticism true? Was the response really that poor? This article offers a framework for the analysis and assessment of a large-scale response to a mega disaster, which is then applied to the Katrina response (with an emphasis on New Orleans). The article identifies some failings (where the response could and should have been better) but also points to successes that somehow got lost in the politicized aftermath of this disaster. The article demonstrates the importance of a proper framework based on insights from crisis management studies.

• Hurricane Katrina
• U.S. disaster response
• New Orleans
• strategic crisis management
• crisis leadership
• crisis analysis

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Hurricane Katrina: Who Stayed and Why?

• Agricultural Economics, Sociology and Education

Research output : Contribution to journal › Article › peer-review

This paper contributes to the growing body of social science research on population displacement from disasters by examining the social determinants of evacuation behavior. It seeks to clarify the effects of race and socioeconomic status on evacuation outcomes vis-a-vis previous research on Hurricane Katrina, and it expands upon prior research on evacuation behavior more generally by differentiating non-evacuees according to their reasons for staying. This research draws upon the Harvard Medical School Hurricane Katrina Community Advisory Group's 2006 survey of individuals affected by Hurricane Katrina. Using these data, we develop two series of logistic regression models. The first set of models predicts the odds that respondents evacuated prior to the storm, relative to delayed- or non-evacuation; the second group of models predicts the odds that non-evacuees were unable to evacuate relative to having chosen to stay. We find that black and low-education respondents were least likely to evacuate prior to the storm and among non-evacuees, most likely to have been unable to evacuate. Respondents' social networks, information attainment, and geographic location also affected evacuation behavior. We discuss these findings and outline directions for future research.

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• Management, Monitoring, Policy and Law

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• 10.1007/s11113-013-9302-9

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• hurricane Earth & Environmental Sciences 100%
• socioeconomic status Earth & Environmental Sciences 26%
• social network Earth & Environmental Sciences 23%
• social science Earth & Environmental Sciences 22%
• disaster Social Sciences 21%
• social status Social Sciences 20%
• logistics Social Sciences 20%
• determinants Social Sciences 18%

T1 - Hurricane Katrina

T2 - Who Stayed and Why?

AU - Thiede, Brian C.

AU - Brown, David L.

N1 - Funding Information: Acknowledgments This article benefitted greatly from the insights of Max Pfeffer, Scott Sanders, Laura Hathaway, and anonymous reviewers. The authors alone are responsible for mistakes of any kind. This research was supported by the Cornell Population Center, Cornell Population and Development Program, and USDA multi-state research project W-2001 ‘‘Population Dynamics and Change: Aging, Ethnicity and Land Use Change in Rural Communities,’’ administered by the Cornell University Agricultural Experiment Station project 159-6808.

PY - 2013/12

Y1 - 2013/12

N2 - This paper contributes to the growing body of social science research on population displacement from disasters by examining the social determinants of evacuation behavior. It seeks to clarify the effects of race and socioeconomic status on evacuation outcomes vis-a-vis previous research on Hurricane Katrina, and it expands upon prior research on evacuation behavior more generally by differentiating non-evacuees according to their reasons for staying. This research draws upon the Harvard Medical School Hurricane Katrina Community Advisory Group's 2006 survey of individuals affected by Hurricane Katrina. Using these data, we develop two series of logistic regression models. The first set of models predicts the odds that respondents evacuated prior to the storm, relative to delayed- or non-evacuation; the second group of models predicts the odds that non-evacuees were unable to evacuate relative to having chosen to stay. We find that black and low-education respondents were least likely to evacuate prior to the storm and among non-evacuees, most likely to have been unable to evacuate. Respondents' social networks, information attainment, and geographic location also affected evacuation behavior. We discuss these findings and outline directions for future research.

AB - This paper contributes to the growing body of social science research on population displacement from disasters by examining the social determinants of evacuation behavior. It seeks to clarify the effects of race and socioeconomic status on evacuation outcomes vis-a-vis previous research on Hurricane Katrina, and it expands upon prior research on evacuation behavior more generally by differentiating non-evacuees according to their reasons for staying. This research draws upon the Harvard Medical School Hurricane Katrina Community Advisory Group's 2006 survey of individuals affected by Hurricane Katrina. Using these data, we develop two series of logistic regression models. The first set of models predicts the odds that respondents evacuated prior to the storm, relative to delayed- or non-evacuation; the second group of models predicts the odds that non-evacuees were unable to evacuate relative to having chosen to stay. We find that black and low-education respondents were least likely to evacuate prior to the storm and among non-evacuees, most likely to have been unable to evacuate. Respondents' social networks, information attainment, and geographic location also affected evacuation behavior. We discuss these findings and outline directions for future research.

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Hurricane Katrina: Who Stayed and Why?

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This paper contributes to the growing body of social science research on population displacement from disasters by examining the social determinants of evacuation behavior. It seeks to clarify the effects of race and socioeconomic status on evacuation outcomes vis-a-vis previous research on Hurricane Katrina, and it expands upon prior research on evacuation behavior more generally by differentiating non-evacuees according to their reasons for staying. This research draws upon the Harvard Medical School Hurricane Katrina Community Advisory Group’s 2006 survey of individuals affected by Hurricane Katrina. Using these data, we develop two series of logistic regression models. The first set of models predicts the odds that respondents evacuated prior to the storm, relative to delayed- or non-evacuation; the second group of models predicts the odds that non-evacuees were unable to evacuate relative to having chosen to stay. We find that black and low-education respondents were least likely to evacuate prior to the storm and among non-evacuees, most likely to have been unable to evacuate. Respondents’ social networks, information attainment, and geographic location also affected evacuation behavior. We discuss these findings and outline directions for future research.

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An empirical analysis of hurricane evacuation expenditures.

High-resolution human mobility data reveal race and wealth disparities in disaster evacuation patterns

Disaster Disparities and Differential Recovery in New Orleans

As justified later in the paper and in footnote #10, we use a measure of education as an indicator of household socioeconomic status. We refer to “education effects” when discussing the particular findings of our statistical models, but refer to “socioeconomic status” when discussing the conceptualization of our research question and referring to previous literature on evacuation behavior, which has utilized multiple indicators of socioeconomic status.

An extensive review by Dash and Gladwin ( 2007 ) demonstrates that previous research on this topic has examined the effect of numerous other characteristics of evacuees and non-evacuees (e.g., gender), as well as the psychosocial dimensions of the evacuation process.

Gallup Poll #2005-45.

Household evacuation strategies were categorized according to (a) the timing of evacuation and (b) whether or not household members remained united or divided.

Both Elliott and Pais ( 2006 ) and Haney et al. ( 2007 ) report a number of other statistically significant factors in their models. Elliot and Pais find significant gender differences in some comparisons. Haney et al. observe significant differences in evacuation strategies according to employment, religion, and sex. Because they do not interact with or otherwise affect their findings regarding race and socioeconomic status, we exclude this from our discussion for the sake of brevity.

“Affected areas” are defined as those counties and parishes that were declared eligible for “individual assistance” by FEMA.

Adjustments were made for overlap in the sampling frames (see Hurricane Katrina Community Advisory Group 2006 for details).

To easily interpret odds ratios <1.000, one should invert the coefficient \(\left( {\frac{1}{\beta }} \right)\) . The quotient expresses the degree to which respondents in group k of variable x i were less likely to experience outcome Y 1 than those in the reference group, in the same terms as coefficients above 1.000.

Although an income variable was also available, we found that education and income were significantly and strongly correlated ( r = 0.417). We chose to use education and exclude the income variable for two primary reasons. First, the income variable reports household income, which is not appropriate given that our outcome and all other explanatory variables are individual-level indicators. Second, income is more prone to reporting bias than education.

We consider responses of 0–4 to either of the following questions “low” and responses of 5+ “high”: (1) “about how many friends or relatives in the county/parish were you close enough to that you could talk about your private feelings without feeling embarrassed?”; and (2) “about how many friends or relatives who did not live in the country/parish were you close enough to that you could talk about your private feelings without feeling embarrassed?” The median responses to these questions were 5.0 and 4.0, respectively, therefore 4.0 provides a reasonable central point around which to assign respondents to these categories.

Although some respondents’ social network classification may reflect socially insignificant county/parish boundary lines, we have no reason to believe that the distribution of such boundary effects is non-random across the four social network categories or any other variable in our statistical models.

We also consider the possibility that information attainment reflects the respondent’s connection to (isolation from) mainstream society.

This variable consists of three categories: we consider 0–4 recommendations “low” information attainment, 5–15 “medium”, and 16 or greater “high.” These thresholds distribute respondents as evenly as possible across the three categories.

Tables  2 and 3 show the percentage of respondents in each category of each explanatory variable that experienced a given evacuation outcome. For example, we show that among high school dropouts, 31.2 % evacuated prior to the storm and 68.8 % did not evacuate prior to the storm.

This includes systematic reporting biases.

Due to confidentiality restrictions, we were unable to obtain respondents’ zip codes of residence from the Harvard study to link community- and individual-level data. We would have liked, for example, to examine whether living in neighborhoods with high poverty or nativity rates affected the odds that an individual evacuated and the reason for not evacuating.

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Acknowledgments

This article benefitted greatly from the insights of Max Pfeffer, Scott Sanders, Laura Hathaway, and anonymous reviewers. The authors alone are responsible for mistakes of any kind. This research was supported by the Cornell Population Center, Cornell Population and Development Program, and USDA multi-state research project W-2001 “Population Dynamics and Change: Aging, Ethnicity and Land Use Change in Rural Communities,” administered by the Cornell University Agricultural Experiment Station project 159-6808.

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Bulletin on Aging & Health

Mortality Impacts of Hurricane Katrina

Hurricane Katrina was the costliest storm of its type to ever strike the U.S. mainland. The 2005 storm killed nearly 2,000 individuals and displaced more than one million residents, resulting in the largest migration of U.S. residents since the 1930s Dust Bowl. While the immediate death toll of the storm is well known, the long-term effects of the storm and resulting displacement on health and longevity are less well understood. Former New Orleans residents dispersed across the U.S., raising the possibility that local conditions may have affected the health of movers. In Does When You Die Depend on Where You Live? Evidence from Hurricane Katrina (NBER Working Paper No. 24822 ), researchers T atyana Deryugina and David Molitor examine the long-run mortality impacts of Hurricane Katrina on the elderly and disabled population of New Orleans.

This vulnerable population was deeply impacted by the hurricane — over one half of those killed by the immediate impact of the storm were over age 75, and elderly Medicare beneficiaries made up one-fifth of the displaced population. While the storm and subsequent displacement may have been scarring for this group's health in the short term, moving to areas with better economic and health outcomes may have generated long-term health benefits. Using Medicare administrative data, the researchers identify Medicare beneficiaries living in New Orleans before the storm and track their mobility and mortality over the following eight years. They compare the mortality outcomes of this group to a comparable group of beneficiaries living in 10 control cities before the storm. The researchers find that the mortality rate of the New Orleans beneficiaries was 0.5 percentage points higher in 2005 (the year of the storm), representing an increase of over 10 percent. Most of these excess deaths occurred within a week of the hurricane's landfall. By contrast, Hurricane Katrina led to sustained mortality reductions over the following eight years for those living in New Orleans at the time of the storm. Including the initial storm-related deaths, the hurricane increased the probability of surviving to 2013 by 1.7 percentage points, a nearly 3 percent increase relative to the eight-year survival probability. This result is not explained by healthier beneficiaries being more likely to survive the storm, since the calculation includes storm-related deaths. To explore the role of place in health, the researchers compare mortality outcomes for elderly beneficiaries who left New Orleans for low-mortality regions versus those who left for high-mortality regions. They find a strong relationship between mortality in the destination region and the movers' mortality — with every one-point increase in the destination mortality rate, there is a 0.8 to 0.9 point increase in the movers' mortality. They estimate that 70 percent of the long-run mortality decline is attributable to the change in local mortality rate experienced by hurricane victims. Despite a high death toll in the immediate aftermath of the storm, Hurricane Katrina reduced long-run mortality among elderly and disabled Medicare beneficiaries by inducing relocation to lower-mortality regions. This study joins a growing literature highlighting the critical effect of place on health. As the researchers note, "[o]ur finding that a migrant's individual mortality risk corresponds closely to the destination region's mortality rate suggests that local public health conditions are an important determinant of individual health outcomes, at least for the elderly and disabled populations."

The authors acknowledge funding from the National Institute on Aging (grant R21AG050795).

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Chapter Five: Lessons Learned

This government will learn the lessons of Hurricane Katrina. We are going to review every action and make necessary changes so that we are better prepared for any challenge of nature, or act of evil men, that could threaten our people.

-- President George W. Bush, September 15, 2005 1

The preceding chapters described the dynamics of the response to Hurricane Katrina. While there were numerous stories of great professionalism, courage, and compassion by Americans from all walks of life, our task here is to identify the critical challenges that undermined and prevented a more efficient and effective Federal response. In short, what were the key failures during the Federal response to Hurricane Katrina?

Hurricane Katrina Critical Challenges

• National Preparedness
• Integrated Use of Military Capabilities
• Communications
• Logistics and Evacuations
• Search and Rescue
• Public Safety and Security
• Public Health and Medical Support
• Human Services
• Mass Care and Housing
• Public Communications
• Critical Infrastructure and Impact Assessment
• Environmental Hazards and Debris Removal
• Foreign Assistance
• Non-Governmental Aid
• Training, Exercises, and Lessons Learned
• Homeland Security Professional Development and Education
• Citizen and Community Preparedness

We ask this question not to affix blame. Rather, we endeavor to find the answers in order to identify systemic gaps and improve our preparedness for the next disaster – natural or man-made. We must move promptly to understand precisely what went wrong and determine how we are going to fix it.

After reviewing and analyzing the response to Hurricane Katrina, we identified seventeen specific lessons the Federal government has learned. These lessons, which flow from the critical challenges we encountered, are depicted in the accompanying text box. Fourteen of these critical challenges were highlighted in the preceding Week of Crisis section and range from high-level policy and planning issues (e.g., the Integrated Use of Military Capabilities) to operational matters (e.g., Search and Rescue). 2 Three other challenges – Training, Exercises, and Lessons Learned; Homeland Security Professional Development and Education; and Citizen and Community Preparedness – are interconnected to the others but reflect measures and institutions that improve our preparedness more broadly. These three will be discussed in the Report’s last chapter, Transforming National Preparedness.

Some of these seventeen critical challenges affected all aspects of the Federal response. Others had an impact on a specific, discrete operational capability. Yet each, particularly when taken in aggregate, directly affected the overall efficiency and effectiveness of our efforts. This chapter summarizes the challenges that ultimately led to the lessons we have learned. Over one hundred recommendations for corrective action flow from these lessons and are outlined in detail in Appendix A of the Report.

Critical Challenge: National Preparedness

Our current system for homeland security does not provide the necessary framework to manage the challenges posed by 21st Century catastrophic threats. But to be clear, it is unrealistic to think that even the strongest framework can perfectly anticipate and overcome all challenges in a crisis. While we have built a response system that ably handles the demands of a typical hurricane season, wildfires, and other limited natural and man-made disasters, the system clearly has structural flaws for addressing catastrophic events. During the Federal response to Katrina 3 , four critical flaws in our national preparedness became evident: Our processes for unified management of the national response; command and control structures within the Federal government; knowledge of our preparedness plans; and regional planning and coordination. A discussion of each follows below.

Unified Management of the National Response

Effective incident management of catastrophic events requires coordination of a wide range of organizations and activities, public and private. Under the current response framework, the Federal government merely “coordinates” resources to meet the needs of local and State governments based upon their requests for assistance. Pursuant to the National Incident Management System (NIMS) and the National Response Plan (NRP), Federal and State agencies build their command and coordination structures to support the local command and coordination structures during an emergency. Yet this framework does not address the conditions of a catastrophic event with large scale competing needs, insufficient resources, and the absence of functioning local governments. These limitations proved to be major inhibitors to the effective marshalling of Federal, State, and local resources to respond to Katrina.

Soon after Katrina made landfall, State and local authorities understood the devastation was serious but, due to the destruction of infrastructure and response capabilities, lacked the ability to communicate with each other and coordinate a response. Federal officials struggled to perform responsibilities generally conducted by State and local authorities, such as the rescue of citizens stranded by the rising floodwaters, provision of law enforcement, and evacuation of the remaining population of New Orleans, all without the benefit of prior planning or a functioning State/local incident command structure to guide their efforts.

The Federal government cannot and should not be the Nation’s first responder. State and local governments are best positioned to address incidents in their jurisdictions and will always play a large role in disaster response. But Americans have the right to expect that the Federal government will effectively respond to a catastrophic incident. When local and State governments are overwhelmed or incapacitated by an event that has reached catastrophic proportions, only the Federal government has the resources and capabilities to respond. The Federal government must therefore plan, train, and equip to meet the requirements for responding to a catastrophic event.

Command and Control Within the Federal Government

In terms of the management of the Federal response, our architecture of command and control mechanisms as well as our existing structure of plans did not serve us well. Command centers in the Department of Homeland Security (DHS) and elsewhere in the Federal government had unclear, and often overlapping, roles and responsibilities that were exposed as flawed during this disaster. The Secretary of Homeland Security, is the President’s principal Federal official for domestic incident management, but he had difficulty coordinating the disparate activities of Federal departments and agencies. The Secretary lacked real-time, accurate situational awareness of both the facts from the disaster area as well as the on-going response activities of the Federal, State, and local players.

The National Response Plan’s Mission Assignment process proved to be far too bureaucratic to support the response to a catastrophe. Melvin Holden, Mayor-President of Baton Rouge, Louisiana, noted that, “requirements for paper work and form completions hindered immediate action and deployment of people and materials to assist in rescue and recovery efforts.” 4 Far too often, the process required numerous time consuming approval signatures and data processing steps prior to any action, delaying the response. As a result, many agencies took action under their own independent authorities while also responding to mission assignments from the Federal Emergency Management Agency (FEMA), creating further process confusion and potential duplication of efforts.

This lack of coordination at the Federal headquarters-level reflected confusing organizational structures in the field. As noted in the Week of Crisis chapter, because the Principal Federal Official (PFO) has coordination authority but lacks statutory authority over the Federal Coordinating Officer (FCO), inefficiencies resulted when the second PFO was appointed. The first PFO appointed for Katrina did not have this problem because, as the Director of FEMA, he was able to directly oversee the FCOs because they fell under his supervisory authority. 5 Future plans should ensure that the PFO has the authority required to execute these responsibilities.

Moreover, DHS did not establish its NRP-specified disaster site multi-agency coordination center—the Joint Field Office (JFO)—until after the height of the crisis. 6 Further, without subordinate JFO structures to coordinate Federal response actions near the major incident sites, Federal response efforts in New Orleans were not initially well-coordinated. 7

Lastly, the Emergency Support Functions (ESFs) did not function as envisioned in the NRP. First, since the ESFs do not easily integrate into the NIMS Incident Command System (ICS) structure, competing systems were implemented in the field – one based on the ESF structure and a second based on the ICS. Compounding the coordination problem, the agencies assigned ESF responsibilities did not respect the role of the PFO. As VADM Thad Allen stated, “The ESF structure currently prevents us from coordinating effectively because if agencies responsible for their respective ESFs do not like the instructions they are receiving from the PFO at the field level, they go to their headquarters in Washington to get decisions reversed. This is convoluted, inefficient, and inappropriate during emergency conditions. Time equals lives saved.”

Knowledge and Practice in the Plans

At the most fundamental level, part of the explanation for why the response to Katrina did not go as planned is that key decision-makers at all levels simply were not familiar with the plans. The NRP was relatively new to many at the Federal, State, and local levels before the events of Hurricane Katrina. 8 This lack of understanding of the “National” plan not surprisingly resulted in ineffective coordination of the Federal, State, and local response. Additionally, the NRP itself provides only the ‘base plan’ outlining the overall elements of a response: Federal departments and agencies were required to develop supporting operational plans and standard operating procedures (SOPs) to integrate their activities into the national response. 9 In almost all cases, the integrating SOPs were either non-existent or still under development when Hurricane Katrina hit. Consequently, some of the specific procedures and processes of the NRP were not properly implemented, and Federal partners had to operate without any prescribed guidelines or chains of command.

Furthermore, the JFO staff and other deployed Federal personnel often lacked a working knowledge of NIMS or even a basic understanding of ICS principles. As a result, valuable time and resources were diverted to provide on-the-job ICS training to Federal personnel assigned to the JFO. This inability to place trained personnel in the JFO had a detrimental effect on operations, as there were not enough qualified persons to staff all of the required positions. We must require all incident management personnel to have a working knowledge of NIMS and ICS principles.

Insufficient Regional Planning and Coordination

The final structural flaw in our current system for national preparedness is the weakness of our regional planning and coordination structures. Guidance to governments at all levels is essential to ensure adequate preparedness for major disasters across the Nation. To this end, the Interim National Preparedness Goal (NPG) and Target Capabilities List (TCL) can assist Federal, State, and local governments to: identify and define required capabilities and what levels of those capabilities are needed; establish priorities within a resource-constrained environment; clarify and understand roles and responsibilities in the national network of homeland security capabilities; and develop mutual aid agreements.

Since incorporating FEMA in March 2003, DHS has spread FEMA’s planning and coordination capabilities and responsibilities among DHS’s other offices and bureaus. DHS also did not maintain the personnel and resources of FEMA’s regional offices. 10 FEMA’s ten regional offices are responsible for assisting multiple States and planning for disasters, developing mitigation programs, and meeting their needs when major disasters occur. During Katrina, eight out of the ten FEMA Regional Directors were serving in an acting capacity and four of the six FEMA headquarters operational division directors were serving in an acting capacity. While qualified acting directors filled in, it placed extra burdens on a staff that was already stretched to meet the needs left by the vacancies.

Additionally, many FEMA programs that were operated out of the FEMA regions, such as the State and local liaison program and all grant programs, have moved to DHS headquarters in Washington. When programs operate out of regional offices, closer relationships are developed among all levels of government, providing for stronger relationships at all levels. By the same token, regional personnel must remember that they represent the interests of the Federal government and must be cautioned against losing objectivity or becoming mere advocates of State and local interests. However, these relationships are critical when a crisis situation develops, because individuals who have worked and trained together daily will work together more effectively during a crisis.

Lessons Learned:

The Federal government should work with its homeland security partners in revising existing plans, ensuring a functional operational structure - including within regions - and establishing a clear, accountable process for all National preparedness efforts.  In doing so, the Federal government must:

• Ensure that Executive Branch agencies are organized, trained, and equipped to perform their response roles.
• Finalize and implement the National Preparedness Goal.

Critical Challenge: Integrated Use of Military Capabilities

The Federal response to Hurricane Katrina demonstrates that the Department of Defense (DOD) has the capability to play a critical role in the Nation’s response to catastrophic events. During the Katrina response, DOD – both National Guard and active duty forces – demonstrated that along with the Coast Guard it was one of the only Federal departments that possessed real operational capabilities to translate Presidential decisions into prompt, effective action on the ground. In addition to possessing operational personnel in large numbers that have been trained and equipped for their missions, DOD brought robust communications infrastructure, logistics, and planning capabilities. Since DOD, first and foremost, has its critical overseas mission, the solution to improving the Federal response to future catastrophes cannot simply be “let the Department of Defense do it.” Yet DOD capabilities must be better identified and integrated into the Nation’s response plans.

The Federal response to Hurricane Katrina highlighted various challenges in the use of military capabilities during domestic incidents. For instance, limitations under Federal law and DOD policy caused the active duty military to be dependent on requests for assistance. These limitations resulted in a slowed application of DOD resources during the initial response. Further, active duty military and National Guard operations were not coordinated and served two different bosses, one the President and the other the Governor.

Limitations to Department of Defense Response Authority

For Federal domestic disaster relief operations, DOD currently uses a “pull” system that provides support to civil authorities based upon specific requests from local, State, or Federal authorities. 11 This process can be slow and bureaucratic. Assigning active duty military forces or capabilities to support disaster relief efforts usually requires a request from FEMA 12 , an assessment by DOD on whether the request can be supported, approval by the Secretary of Defense or his designated representative, and a mission assignment for the military forces or capabilities to provide the requested support. From the time a request is initiated until the military force or capability is delivered to the disaster site requires a 21-step process. 13 While this overly bureaucratic approach has been adequate for most disasters, in a catastrophic event like Hurricane Katrina the delays inherent in this “pull” system of responding to requests resulted in critical needs not being met. 14 One could imagine a situation in which a catastrophic event is of such a magnitude that it would require an even greater role for the Department of Defense. For these reasons, we should both expedite the mission assignment request and the approval process, but also define the circumstances under which we will push resources to State and local governments absent a request.

Unity of Effort among Active Duty Forces and the National Guard

In the overall response to Hurricane Katrina, separate command structures for active duty military and the National Guard hindered their unity of effort. U.S. Northern Command (USNORTHCOM) commanded active duty forces, while each State government commanded its National Guard forces. For the first two days of Katrina response operations, USNORTHCOM did not have situational awareness of what forces the National Guard had on the ground. Joint Task Force Katrina (JTF-Katrina) simply could not operate at full efficiency when it lacked visibility of over half the military forces in the disaster area. 15 Neither the Louisiana National Guard nor JTF-Katrina had a good sense for where each other’s forces were located or what they were doing. For example, the JTF-Katrina Engineering Directorate had not been able to coordinate with National Guard forces in the New Orleans area. As a result, some units were not immediately assigned missions matched to on-the-ground requirements. Further, FEMA requested assistance from DOD without knowing what State National Guard forces had already deployed to fill the same needs. 16

Also, the Commanding General of JTF-Katrina and the Adjutant Generals (TAGs) of Louisiana and Mississippi had only a coordinating relationship, with no formal command relationship established. This resulted in confusion over roles and responsibilities between National Guard and Federal forces and highlights the need for a more unified command structure. 17

Structure and Resources of the National Guard

As demonstrated during the Hurricane Katrina response, the National Guard Bureau (NGB) is a significant joint force provider for homeland security missions. Throughout the response, the NGB provided continuous and integrated reporting of all National Guard assets deployed in both a Federal and non-Federal status to USNORTHCOM, Joint Forces Command, Pacific Command, and the Assistant Secretary of Defense for Homeland Defense. This is an important step toward achieving unity of effort. However, NGB’s role in homeland security is not yet clearly defined. The Chief of the NGB has made a recommendation to the Secretary of Defense that NGB be chartered as a joint activity of the DOD. 18 Achieving these efforts will serve as the foundation for National Guard transformation and provide a total joint force capability for homeland security missions. 19

The Departments of Homeland Security and Defense should jointly plan for the Department of Defense’s support of Federal response activities as well as those extraordinary circumstances when it is appropriate for the Department of Defense to lead the Federal response. In addition, the Department of Defense should ensure the transformation of the National Guard is focused on increased integration with active duty forces for homeland security plans and activities.

Critical Challenge: Communications

Hurricane Katrina destroyed an unprecedented portion of the core communications infrastructure throughout the Gulf Coast region. As described earlier in the Report, the storm debilitated 911 emergency call centers, disrupting local emergency services. 20 Nearly three million customers lost telephone service. Broadcast communications, including 50 percent of area radio stations and 44 percent of area television stations, similarly were affected. 21 More than 50,000 utility poles were toppled in Mississippi alone, meaning that even if telephone call centers and electricity generation capabilities were functioning, the connections to the customers were broken. 22 Accordingly, the communications challenges across the Gulf Coast region in Hurricane Katrina’s wake were more a problem of basic operability 23 , than one of equipment or system interoperability . 24 The complete devastation of the communications infrastructure left emergency responders and citizens without a reliable network across which they could coordinate. 25

Although Federal, State, and local agencies had communications plans and assets in place, these plans and assets were neither sufficient nor adequately integrated to respond effectively to the disaster. 26 Many available communications assets were not utilized fully because there was no national, State-wide, or regional communications plan to incorporate them. For example, despite their contributions to the response effort, the U.S. Department of Agriculture (USDA) Forest Service’s radio cache—the largest civilian cache of radios in the United States—had additional radios available that were not utilized. 27

Federal, State, and local governments have not yet completed a comprehensive strategy to improve operability and interoperability to meet the needs of emergency responders. 28 This inability to connect multiple communications plans and architectures clearly impeded coordination and communication at the Federal, State, and local levels. A comprehensive, national emergency communications strategy is needed to confront the challenges of incorporating existing equipment and practices into a constantly changing technological and cultural environment. 29

The Department of Homeland Security should review our current laws, policies, plans, and strategies relevant to communications. Upon the conclusion of this review, the Homeland Security Council, with support from the Office of Science and Technology Policy, should develop a National Emergency Communications Strategy that supports communications operability and interoperability.

Critical Challenge: Logistics and Evacuation

The scope of Hurricane Katrina’s devastation, the effects on critical infrastructure in the region, and the debilitation of State and local response capabilities combined to produce a massive requirement for Federal resources. The existing planning and operational structure for delivering critical resources and humanitarian aid clearly proved to be inadequate to the task. The highly bureaucratic supply processes of the Federal government were not sufficiently flexible and efficient, and failed to leverage the private sector and 21st Century advances in supply chain management.

Throughout the response, Federal resource managers had great difficulty determining what resources were needed, what resources were available, and where those resources were at any given point in time. Even when Federal resource managers had a clear understanding of what was needed, they often could not readily determine whether the Federal government had that asset, or what alternative sources might be able to provide it. As discussed in the Week of Crisis chapter, even when an agency came directly to FEMA with a list of available resources that would be useful during the response, there was no effective mechanism for efficiently integrating and deploying these resources. Nor was there an easy way to find out whether an alternative source, such as the private sector or a charity, might be able to better fill the need. Finally, FEMA’s lack of a real-time asset-tracking system – a necessity for successful 21st Century businesses – left Federal managers in the dark regarding the status of resources once they were shipped. 30

Our logistics system for the 21st Century should be a fully transparent, four-tiered system. First, we must encourage and ultimately require State and local governments to pre-contract for resources and commodities that will be critical for responding to all hazards. Second, if these arrangements fail, affected State governments should ask for additional resources from other States through the Emergency Management Assistance Compact (EMAC) process. Third, if such interstate mutual aid proves insufficient, the Federal government, having the benefit of full transparency, must be able to assist State and local governments to move commodities regionally. But in the end, FEMA must be able to supplement and, in catastrophic incidents, supplant State and local systems with a fully modern approach to commodity management.

The Department of Homeland Security, in coordination with State and local governments and the private sector, should develop a modern, flexible, and transparent logistics system.  This system should be based on established contracts for stockpiling commodities at the local level for emergencies and the provision of goods and services during emergencies.  The Federal government must develop the capacity to conduct large-scale logistical operations that supplement and, if necessary, replace State and local logistical systems by leveraging resources within both the public sector and the private sector.

With respect to evacuation—fundamentally a State and local responsibility—the Hurricane Katrina experience demonstrates that the Federal government must be prepared to fulfill the mission if State and local efforts fail. Unfortunately, a lack of prior planning combined with poor operational coordination generated a weak Federal performance in supporting the evacuation of those most vulnerable in New Orleans and throughout the Gulf Coast following Katrina’s landfall. The Federal effort lacked critical elements of prior planning, such as evacuation routes, communications, transportation assets, evacuee processing, and coordination with State, local, and non-governmental officials receiving and sheltering the evacuees. Because of poor situational awareness and communications throughout the evacuation operation, FEMA had difficulty providing buses through ESF-1, Transportation, (with the Department of Transportation as the coordinating agency). 31 FEMA also had difficulty delivering food, water, and other critical commodities to people waiting to be evacuated, most significantly at the Superdome. 32

The Department of Transportation, in coordination with other appropriate departments of the Executive Branch, must also be prepared to conduct mass evacuation operations when disasters overwhelm or incapacitate State and local governments.

Critical Challenge: Search and Rescue

After Hurricane Katrina made landfall, rising floodwaters stranded thousands in New Orleans on rooftops, requiring a massive civil search and rescue operation. The Coast Guard, FEMA Urban Search and Rescue (US&R) Task Forces 33 , and DOD forces 34 , in concert with State and local emergency responders from across the country, courageously combined to rescue tens of thousands of people. With extraordinary ingenuity and tenacity, Federal, State, and local emergency responders plucked people from rooftops while avoiding urban hazards not normally encountered during waterborne rescue. 35

Yet many of these courageous lifesavers were put at unnecessary risk by a structure that failed to support them effectively. The overall search and rescue effort demonstrated the need for greater coordination between US&R, the Coast Guard, and military responders who, because of their very different missions, train and operate in very different ways. For example, Urban Search and Rescue (US&R) teams had a particularly challenging situation since they are neither trained nor equipped to perform water rescue. Thus they could not immediately rescue people trapped by the flood waters. 36

Furthermore, lacking an integrated search and rescue incident command, the various agencies were unable to effectively coordinate their operations. 37 This meant that multiple rescue teams were sent to the same areas, while leaving others uncovered. 38 When successful rescues were made, there was no formal direction on where to take those rescued. 39 Too often rescuers had to leave victims at drop-off points and landing zones that had insufficient logistics, medical, and communications resources, such as atop the I-10 cloverleaf near the Superdome. 40

The Department of Homeland Security should lead an interagency review of current policies and procedures to ensure effective integration of all Federal search and rescue assets during disaster response.

Critical Challenge: Public Safety and Security

State and local governments have a fundamental responsibility to provide for the public safety and security of their residents. During disasters, the Federal government provides law enforcement assistance only when those resources are overwhelmed or depleted. 41 Almost immediately following Hurricane Katrina’s landfall, law and order began to deteriorate in New Orleans. The city’s overwhelmed police force–70 percent of which were themselves victims of the disaster—did not have the capacity to arrest every person witnessed committing a crime, and many more crimes were undoubtedly neither observed by police nor reported. The resulting lawlessness in New Orleans significantly impeded—and in some cases temporarily halted—relief efforts and delayed restoration of essential private sector services such as power, water, and telecommunications. 42

The Federal law enforcement response to Hurricane Katrina was a crucial enabler to the reconstitution of the New Orleans Police Department’s command structure as well as the larger criminal justice system. Joint leadership from the Department of Justice and the Department of Homeland Security integrated the available Federal assets into the remaining local police structure and divided the Federal law enforcement agencies into corresponding New Orleans Police Department districts.

While the deployment of Federal law enforcement capability to New Orleans in a dangerous and chaotic environment significantly contributed to the restoration of law and order, pre-event collaborative planning between Federal, State, and local officials would have improved the response. Indeed, Federal, State, and local law enforcement officials performed admirably in spite of a system that should have better supported them. Local, State, and Federal law enforcement were ill-prepared and ill-positioned to respond efficiently and effectively to the crisis.

In the end, it was clear that Federal law enforcement support to State and local officials required greater coordination, unity of command, collaborative planning and training with State and local law enforcement, as well as detailed implementation guidance. For example, the Federal law enforcement response effort did not take advantage of all law enforcement assets embedded across Federal departments and agencies. Several departments promptly offered their assistance, but their law enforcement assets were incorporated only after weeks had passed, or not at all. 43

Coordination challenges arose even after Federal law enforcement personnel arrived in New Orleans. For example, several departments and agencies reported that the procedures for becoming deputized to enforce State law were cumbersome and inefficient. In Louisiana, a State Police attorney had to physically be present to swear in Federal agents. Many Federal law enforcement agencies also had to complete a cumbersome Federal deputization process. 44 New Orleans was then confronted with a rapid influx of law enforcement officers from a multitude of States and jurisdictions—each with their own policies and procedures, uniforms, and rules on the use of force—which created the need for a command structure to coordinate their efforts. 45

Hurricane Katrina also crippled the region’s criminal justice system. Problems such as a significant loss of accountability of many persons under law enforcement supervision 46 , closure of the court systems in the disaster 47 , and hasty evacuation of prisoners 48 were largely attributable to the absence of contingency plans at all levels of government.

The Department of Justice, in coordination with the Department of Homeland Security, should examine Federal responsibilities for support to State and local law enforcement and criminal justice systems during emergencies and then build operational plans, procedures, and policies to ensure an effective Federal law enforcement response.

Critical Challenge: Public Health and Medical Support

Hurricane Katrina created enormous public health and medical challenges, especially in Louisiana and Mississippi—States with public health infrastructures that ranked 49th and 50th in the Nation, respectively. 49 But it was the subsequent flooding of New Orleans that imposed catastrophic public health conditions on the people of southern Louisiana and forced an unprecedented mobilization of Federal public health and medical assets. Tens of thousands of people required medical care. Over 200,000 people with chronic medical conditions, displaced by the storm and isolated by the flooding, found themselves without access to their usual medications and sources of medical care. Several large hospitals were totally destroyed and many others were rendered inoperable. Nearly all smaller health care facilities were shut down. Although public health and medical support efforts restored the capabilities of many of these facilities, the region’s health care infrastructure sustained extraordinary damage. 50

Most local and State public health and medical assets were overwhelmed by these conditions, placing even greater responsibility on federally deployed personnel. Immediate challenges included the identification, triage and treatment of acutely sick and injured patients; the management of chronic medical conditions in large numbers of evacuees with special health care needs; the assessment, communication and mitigation of public health risk; and the provision of assistance to State and local health officials to quickly reestablish health care delivery systems and public health infrastructures. 51

Despite the success of Federal, State, and local personnel in meeting this enormous challenge, obstacles at all levels reduced the reach and efficiency of public health and medical support efforts. In addition, the coordination of Federal assets within and across agencies was poor. The cumbersome process for the authorization of reimbursement for medical and public health services provided by Federal agencies created substantial delays and frustration among health care providers, patients and the general public. 52 In some cases, significant delays slowed the arrival of Federal assets to critical locations. 53 In other cases, large numbers of Federal assets were deployed, only to be grossly underutilized. 54 Thousands of medical volunteers were sought by the Department of Health and Human Services (HHS), and though they were informed that they would likely not be needed unless notified otherwise, many volunteers reported that they received no message to that effect. 55 These inefficiencies were the products of a fragmented command structure for medical response; inadequate evacuation of patients; weak State and local public health infrastructures 56 ; insufficient pre-storm risk communication to the public 57 ; and the absence of a uniform electronic health record system.

In coordination with the Department of Homeland Security and other homeland security partners, the Department of Health and Human Services should strengthen the Federal government’s capability to provide public health and medical support during a crisis.  This will require the improvement of command and control of public health resources, the development of deliberate plans, an additional investment in deployable operational resources, and an acceleration of the initiative to foster the widespread use of interoperable electronic health records systems.

Critical Challenge: Human Services

Disasters—especially those of catastrophic proportions—produce many victims whose needs exceed the capacity of State and local resources. These victims who depend on the Federal government for assistance fit into one of two categories: (1) those who need Federal disaster-related assistance, and (2) those who need continuation of government assistance they were receiving before the disaster, plus additional disaster-related assistance. Hurricane Katrina produced many thousands of both categories of victims. 58

The Federal government maintains a wide array of human service programs to provide assistance to special-needs populations, including disaster victims. 59 Collectively, these programs provide a safety net to particularly vulnerable populations.

The Emergency Support Function 6 (ESF-6) Annex to the NRP assigns responsibility for the emergency delivery of human services to FEMA. While FEMA is the coordinator of ESF-6, it shares primary agency responsibility with the American Red Cross. 60 The Red Cross focuses on mass care (e.g. care for people in shelters), and FEMA continues the human services components for ESF-6 as the mass care effort transitions from the response to the recovery phase. 61 The human services provided under ESF-6 include: counseling; special-needs population support; immediate and short-term assistance for individuals, households, and groups dealing with the aftermath of a disaster; and expedited processing of applications for Federal benefits. 62 The NRP calls for “reducing duplication of effort and benefits, to the extent possible,” to include “streamlining assistance as appropriate.” 63

Prior to Katrina’s landfall along the Gulf Coast and during the subsequent several weeks, Federal preparation for distributing individual assistance proved frustrating and inadequate. Because the NRP did not mandate a single Federal point of contact for all assistance and required FEMA to merely coordinate assistance delivery, disaster victims confronted an enormously bureaucratic, inefficient, and frustrating process that failed to effectively meet their needs. The Federal government’s system for distribution of human services was not sufficiently responsive to the circumstances of a large number of victims—many of whom were particularly vulnerable—who were forced to navigate a series of complex processes to obtain critical services in a time of extreme duress. As mentioned in the preceding chapter, the Disaster Recovery Centers (DRCs) did not provide victims single-point access to apply for the wide array of Federal assistance programs.

The Department of Health and Human Services should coordinate with other departments of the Executive Branch, as well as State governments and non-governmental organizations, to develop a robust, comprehensive, and integrated system to deliver human services during disasters so that victims are able to receive Federal and State assistance in a simple and seamless manner.  In particular, this system should be designed to provide victims a consumer oriented, simple, effective, and single encounter from which they can receive assistance.

Critical Challenge: Mass Care and Housing

Hurricane Katrina resulted in the largest national housing crisis since the Dust Bowl of the 1930s. The impact of this massive displacement was felt throughout the country, with Gulf residents relocating to all fifty States and the District of Columbia. 64 Prior to the storm’s landfall, an exodus of people fled its projected path, creating an urgent need for suitable shelters. Those with the willingness and ability to evacuate generally found temporary shelter or housing. However, the thousands of people in New Orleans who were either unable to move due to health reasons or lack of transportation, or who simply did not choose to comply with the mandatory evacuation order, had significant difficulty finding suitable shelter after the hurricane had devastated the city. 65

Overall, Federal, State, and local plans were inadequate for a catastrophe that had been anticipated for years. Despite the vast shortcomings of the Superdome and other shelters, State and local officials had no choice but to direct thousands of individuals to such sites immediately after the hurricane struck. Furthermore, the Federal government’s capability to provide housing solutions to the displaced Gulf Coast population has proved to be far too slow, bureaucratic, and inefficient.

The Federal shortfall resulted from a lack of interagency coordination to relocate and house people. FEMA’s actions often were inconsistent with evacuees’ needs and preferences. Despite offers from the Departments of Veterans Affairs (VA), Housing and Urban Development (HUD) and Agriculture (USDA) as well as the private sector to provide thousands of housing units nationwide, FEMA focused its housing efforts on cruise ships and trailers, which were expensive and perceived by some to be a means to force evacuees to return to New Orleans. 66 HUD, with extensive expertise and perspective on large-scale housing challenges and its nation-wide relationships with State public housing authorities, was not substantially engaged by FEMA in the housing process until late in the effort. 67 FEMA’s temporary and long-term housing efforts also suffered from the failure to pre-identify workable sites and available land and the inability to take advantage of housing units available with other Federal agencies.

Using established Federal core competencies and all available resources, the Department of Housing and Urban Development, in coordination with other departments of the Executive Branch with housing stock, should develop integrated plans and bolstered capabilities for the temporary and long-term housing of evacuees. The American Red Cross and the Department of Homeland Security should retain responsibility and improve the process of mass care and sheltering during disasters.

Critical Challenge: Public Communications

The Federal government’s dissemination of essential public information prior to Hurricane Katrina’s Gulf landfall is one of the positive lessons learned. The many professionals at the National Oceanic and Atmospheric Administration (NOAA) and the National Hurricane Center worked with diligence and determination in disseminating weather reports and hurricane track predictions as described in the Pre-landfall chapter. This includes disseminating warnings and forecasts via NOAA Radio and the internet, which operates in conjunction with the Emergency Alert System (EAS). 68 We can be certain that their efforts saved lives.

However, more could have been done by officials at all levels of government. For example, the EAS—a mechanism for Federal, State and local officials to communicate disaster information and instructions—was not utilized by State and local officials in Louisiana, Mississippi or Alabama prior to Katrina’s landfall. 69

Further, without timely, accurate information or the ability to communicate, public affairs officers at all levels could not provide updates to the media and to the public. It took several weeks before public affairs structures, such as the Joint Information Centers, were adequately resourced and operating at full capacity. In the meantime, Federal, State, and local officials gave contradictory messages to the public, creating confusion and feeding the perception that government sources lacked credibility. On September 1, conflicting views of New Orleans emerged with positive statements by some Federal officials that contradicted a more desperate picture painted by reporters in the streets. 70 The media, operating 24/7, gathered and aired uncorroborated information which interfered with ongoing emergency response efforts. 71 The Federal public communications and public affairs response proved inadequate and ineffective.

The Department of Homeland Security should develop an integrated public communications plan to better inform, guide, and reassure the American public before, during, and after a catastrophe. The Department of Homeland Security should enable this plan with operational capabilities to deploy coordinated public affairs teams during a crisis.

Critical Challenge: Critical Infrastructure and Impact Assessment

Hurricane Katrina had a significant impact on many sectors of the region’s “critical infrastructure,” especially the energy sector. 72 The Hurricane temporarily caused the shutdown of most crude oil and natural gas production in the Gulf of Mexico as well as much of the refining capacity in Louisiana, Mississippi, and Alabama. “[M]ore than ten percent of the Nation’s imported crude oil enters through the Louisiana Offshore Oil Port” 73 adding to the impact on the energy sector. Additionally, eleven petroleum refineries, or one-sixth of the Nation’s refining capacity, were shut down. 74 Across the region more than 2.5 million customers suffered power outages across Louisiana, Mississippi, and Alabama. 75

While there were successes, the Federal government’s ability to protect and restore the operation of priority national critical infrastructure was hindered by four interconnected problems. First, the NRP-guided response did not account for the need to coordinate critical infrastructure protection and restoration efforts across the Emergency Support Functions (ESFs). The NRP designates the protection and restoration of critical infrastructure as essential objectives of five ESFs: Transportation; Communications; Public Works and Engineering; Agriculture; and Energy. 76 Although these critical infrastructures are necessary to assist in all other response and restoration efforts, there are seventeen critical infrastructure and key resource sectors whose needs must be coordinated across virtually every ESF during response and recovery. 77 Second, the Federal government did not adequately coordinate its actions with State and local protection and restoration efforts. In fact, the Federal government created confusion by responding to individualized requests in an inconsistent manner. 78 Third, Federal, State, and local officials responded to Hurricane Katrina without a comprehensive understanding of the interdependencies of the critical infrastructure sectors in each geographic area and the potential national impact of their decisions. For example, an energy company arranged to have generators shipped to facilities where they were needed to restore the flow of oil to the entire mid-Atlantic United States. However, FEMA regional representatives diverted these generators to hospitals. While lifesaving efforts are always the first priority, there was no overall awareness of the competing important needs of the two requests. Fourth, the Federal government lacked the timely, accurate, and relevant ground-truth information necessary to evaluate which critical infrastructures were damaged, inoperative, or both. The FEMA teams that were deployed to assess damage to the regions did not focus on critical infrastructure and did not have the expertise necessary to evaluate protection and restoration needs. 79

The Interim National Infrastructure Protection Plan (NIPP) provides strategic-level guidance for all Federal, State, and local entities to use in prioritizing infrastructure for protection. 80 However, there is no supporting implementation plan to execute these actions during a natural disaster. Federal, State, and local officials need an implementation plan for critical infrastructure protection and restoration that can be shared across the Federal government, State and local governments, and with the private sector, to provide them with the necessary background to make informed preparedness decisions with limited resources.

The Department of Homeland Security, working collaboratively with the private sector, should revise the National Response Plan and finalize the Interim National Infrastructure Protection Plan to be able to rapidly assess the impact of a disaster on critical infrastructure. We must use this knowledge to inform Federal response and prioritization decisions and to support infrastructure restoration in order to save lives and mitigate the impact of the disaster on the Nation.

Critical Challenge: Environmental Hazards and Debris Removal

The Federal clean-up effort for Hurricane Katrina was an immense undertaking. The storm impact caused the spill of over seven million gallons of oil into Gulf Coast waterways. Additionally, it flooded three Superfund 81 sites in the New Orleans area, and destroyed or compromised numerous drinking water facilities and wastewater treatment plants along the Gulf Coast. 82 The storm’s collective environmental damage, while not creating the “toxic soup” portrayed in the media, nonetheless did create a potentially hazardous environment for emergency responders and the general public. 83 In response, the Environmental Protection Agency (EPA) and the Coast Guard jointly led an interagency environmental assessment and recovery effort, cleaning up the seven million gallons of oil and resolving over 2,300 reported cases of pollution. 84

While this response effort was commendable, Federal officials could have improved the identification of environmental hazards and communication of appropriate warnings to emergency responders and the public. For example, the relatively small number of personnel available during the critical week after landfall were unable to conduct a rapid and comprehensive environmental assessment of the approximately 80 square miles flooded in New Orleans, let alone the nearly 93,000 square miles affected by the hurricane. 85

Competing priorities hampered efforts to assess the environment. Moreover, although the process used to identify environmental hazards provides accurate results, these results are not prompt enough to provide meaningful information to responders. Furthermore, there must be a comprehensive plan to accurately and quickly communicate this critical information to the emergency responders and area residents who need it. 86 Had such a plan existed, the mixed messages from Federal, State, and local officials on the reentry into New Orleans could have been avoided.

Debris Removal

State and local governments are normally responsible for debris removal. However, in the event of a disaster in which State and local governments are overwhelmed and request assistance, the Federal government can provide two forms of assistance: debris removal by the U.S. Army Corps of Engineers (USACE) or other Federal agencies, or reimbursement for locally contracted debris removal. 87

Hurricane Katrina created an estimated 118 million cubic yards of debris. In just five months, 71 million cubic yards of debris have been removed from Louisiana, Mississippi, and Alabama. In comparison, it took six months to remove the estimated 20 million cubic yards of debris created by Hurricane Andrew. 88

However, the unnecessarily complicated rules for removing debris from private property hampered the response. 89 In addition, greater collaboration among Federal, State, and local officials as well as an enhanced public communication program could have improved the effectiveness of the Federal response.

The Department of Homeland Security, in coordination with the Environmental Protection Agency, should oversee efforts to improve the Federal government’s capability to quickly gather environmental data and to provide the public and emergency responders the most accurate information available, to determine whether it is safe to operate in a disaster environment or to return after evacuation. In addition, the Department of Homeland Security should work with its State and local homeland security partners to plan and to coordinate an integrated approach to debris removal during and after a disaster.

Critical Challenge: Managing Offers of Foreign Assistance and Inquiries Regarding Affected Foreign Nationals

Our experience with the tragedies of September 11th and Hurricane Katrina underscored that our domestic crises have international implications. Soon after the extent of Hurricane Katrina’s damage became known, the United States became the beneficiary of an incredible international outpouring of assistance. One hundred fifty-one (151) nations and international organizations offered financial or material assistance to support relief efforts. 90 Also, we found that among the victims were foreign nationals who were in the country on business, vacation, or as residents. Not surprisingly, foreign governments sought information regarding the safety of their citizens.

We were not prepared to make the best use of foreign support. Some foreign governments sought to contribute aid that the United States could not accept or did not require. In other cases, needed resources were tied up by bureaucratic red tape. 91 But more broadly, we lacked the capability to prioritize and integrate such a large quantity of foreign assistance into the ongoing response. Absent an implementation plan for the prioritization and integration of foreign material assistance, valuable resources went unused, and many donor countries became frustrated. 92 While we ultimately overcame these obstacles amidst the crisis, our experience underscores the need for pre-crisis planning.

Nor did we have the mechanisms in place to provide foreign governments with whatever knowledge we had regarding the status of their nationals. Despite the fact that many victims of the September 11, 2001, tragedy were foreign nationals, the NRP does not take into account foreign populations (e.g. long-term residents, students, businessmen, tourists, and foreign government officials) affected by a domestic catastrophe. In addition, Federal, State, and local emergency response officials have not included assistance to foreign nationals in their response planning.

Many foreign governments, as well as the family and friends of foreign nationals, looked to the Department of State for information regarding the safety and location of their citizens after Hurricane Katrina. The absence of a central system to manage and promptly respond to inquires about affected foreign nationals led to confusion. 93

The Department of State, in coordination with the Department of Homeland Security, should review and revise policies, plans, and procedures for the management of foreign disaster assistance. In addition, this review should clarify responsibilities and procedures for handling inquiries regarding affected foreign nationals.

Critical Challenge: Non-governmental Aid

Over the course of the Hurricane Katrina response, a significant capability for response resided in organizations outside of the government. Non-governmental and faith-based organizations, as well as the private sector all made substantial contributions. Unfortunately, the Nation did not always make effective use of these contributions because we had not effectively planned for integrating them into the overall response effort.

Even in the best of circumstances, government alone cannot deliver all disaster relief. Often, non-governmental organizations (NGOs) are the quickest means of providing local relief, but perhaps most importantly, they provide a compassionate, human face to relief efforts. We must recognize that NGOs play a fundamental role in response and recovery efforts and will contribute in ways that are, in many cases, more efficient and effective than the Federal government’s response. We must plan for their participation and treat them as valued and necessary partners.

The number of volunteer, non-profit, faith-based, and private sector entities that aided in the Hurricane Katrina relief effort was truly extraordinary. Nearly every national, regional, and local charitable organization in the United States, and many from abroad, contributed aid to the victims of the storm. Trained volunteers from member organizations of the National Volunteer Organizations Active in Disaster (NVOAD), the American Red Cross, Medical Reserve Corps (MRC), Community Emergency Response Team (CERT), as well as untrained volunteers from across the United States, deployed to Louisiana, Mississippi, and Alabama.

Government sponsored volunteer organizations also played a critical role in providing relief and assistance. For example, the USA Freedom Corps persuaded numerous non-profit organizations and the Governor’s State Service Commissions to list their hurricane relief volunteer opportunities in the USA Freedom Corps volunteer search engine. The USA Freedom Corps also worked with the Corporation for National and Community Service, which helped to create a new, people-driven “Katrina Resource Center” to help volunteers connect their resources with needs on the ground. 94 In addition, 14,000 Citizen Corps volunteers supported response and recovery efforts around the country. 95 This achievement demonstrates that seamless coordination among government agencies and volunteer organizations is possible when they build cooperative relationships and conduct joint planning and exercises before an incident occurs. 96

Faith-based organizations also provided extraordinary services. For example, more than 9,000 Southern Baptist Convention of the North American Mission Board volunteers from forty-one states served in Texas, Louisiana, Mississippi, Alabama, and Georgia. These volunteers ran mobile kitchens and recovery sites. 97 Many smaller, faith-based organizations, such as the Set Free Indeed Ministry in Baton Rouge, Louisiana, brought comfort and offered shelter to the survivors. They used their facilities and volunteers to distribute donated supplies to displaced persons and to meet their immediate needs. 98 Local churches independently established hundreds of “pop-up” shelters to house storm victims. 99

More often than not, NGOs successfully contributed to the relief effort in spite of government obstacles and with almost no government support or direction. Time and again, government agencies did not effectively coordinate relief operations with NGOs. Often, government agencies failed to match relief needs with NGO and private sector capabilities. Even when agencies matched non-governmental aid with an identified need, there were problems moving goods, equipment, and people into the disaster area. For example, the government relief effort was unprepared to meet the fundamental food, housing, and operational needs of the surge volunteer force.

The Federal response should better integrate the contributions of volunteers and non-governmental organizations into the broader national effort.  This integration would be best achieved at the State and local levels, prior to future incidents. In particular, State and local governments must engage NGOs in the planning process, credential their personnel, and provide them the necessary resource support for their involvement in a joint response.

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Four lost pregnancies. Five weeks of IVF injections. One storm.

A couple spent years and tens of thousands of dollars trying to have a baby. then hurricane ian hit..

On their very first date, Kirsti and Justin Mahon talked about wanting kids. They met on a dating app in 2016, nine months after Kirsti moved from Texas to Florida. Almost immediately, they fell in love. 

A little over two years later, they got married. Six months after that, they started trying for a baby. To their surprise, they got pregnant right away. But just as quickly, they had an early miscarriage. At 27, Kirsti didn’t have any reason to suspect fertility problems, and her obstetrician was quick to reassure her: Kirsti’s blood work looked normal, and getting pregnant after a month of trying is a good sign of fertility. Conceiving again, she was told, would be easy. 

Over the next two years, Kirsti got pregnant three more times. None of her pregnancies lasted beyond the first trimester. 

“It felt like we were hitting a brick wall,” Kirsti said. In January 2022, the couple went to see a fertility specialist who conducted a series of intensive tests that uncovered what was really going on. Kirsti was only 29 years old at the time, but the specialist told her that her egg quality was that of a 40-year-old’s. In vitro fertilization, or IVF, the specialist said, was Kirsti and Justin’s best hope.

It didn’t take the couple long to decide to take the plunge. “With every loss that we had it was like I was watching Kirsti lose a piece of herself,” said Justin. “It became obvious with the consultation that the IVF process was really the only way to guarantee that this really brutal cycle wouldn’t continue.”

So they drained their savings, cashed in an old retirement account, and took out two loans to pay for the treatment. They live in Florida, a state where coverage isn’t mandated , so most of the procedures would be out of pocket. Justin estimates it cost between $25,000 and $30,000. The couple hammered out the minutiae of IVF with their specialist, down to the timing of every hormone shot. They felt ready.

But Kirsti and Justin hadn’t accounted for hurricane season.

If the process of getting pregnant naturally feels murky and unpredictable, in vitro fertilization turns conception into a science — every menstrual phase, reproductive hormone and embryo carefully screened, tested, and optimized . First, patients inject themselves with fertility hormones aimed at stimulating ovarian follicles and bringing as many eggs as possible to maturity. An IVF cycle can fail right then and there, with the bad news showing up on an ultrasound screen or on the printed pages of a laboratory test before the eggs are even collected. Often, too few follicles develop. Ovulation can happen prematurely, or the ovaries can become hyperstimulated , causing pain, nausea, or more serious health problems. Everything can go wrong, and everything — down to the timing of each hormone shot — needs to go right.  

If it does, the patient’s eggs are removed for fertilization in an outpatient procedure called an egg retrieval. The eggs must be harvested 34 to 36 hours after the “ trigger shot ,” a final hormone injection which prompts the eggs to finish maturing, but before the ovary releases them into the fallopian tubes. Patients are administered a painkiller, then the doctor guides a needle through the vagina or stomach and into the ovaries, aiming to suction all the eggs from their follicles. Mature eggs — there can be dozens, just one, or none at all — are fertilized with sperm in vitro, Latin for “in the glass,” or in this case in a petri dish. There, the embryos mature for three to six days. Not all of them survive, or develop correctly. The ones that make it can be reinserted into the uterus right away or, more commonly, frozen for later use.

Two time-sensitive procedures bookend the most stressful and critical weeks of the IVF process. The first is the egg retrieval. Once the trigger shot has been administered, there’s no turning back. If the procedure doesn’t take place approximately 36 hours after the injection, the patient’s follicles rupture, casting the precious eggs irretrievably into the fallopian tubes. A missed alarm, a traffic jam, or a delayed flight can wreck an enormous financial and emotional investment. 

The second is the embryo transfer. A patient’s uterine lining must be sufficiently thick when an embryo is reinserted — otherwise, the embryo won’t implant, and the patient won’t get pregnant. Doctors often prescribe additional hormone injections for up to 12 weeks to boost estrogen levels and thicken the uterine lining before a frozen embryo is thawed and transferred. Fertility clinics typically require patients to come in regularly for ultrasounds to determine the optimal day for the transfer. If the lining remains too thin, or if the patient’s menstrual cycle advances too far, then the transfer must be delayed for at least another month. 

These windows of opportunity are narrow, and it doesn’t take much to slam them shut . For a growing number of would-be parents living in the coastal areas of the United States, where climate change is making hurricanes faster-moving and more intense, all it takes is a single storm.

In September 2022, the Mahons were preparing for the final stage of IVF: the embryo transfer. 

Kirsti had already undergone the grueling egg stimulation and retrieval process, which produced 23 eggs. Four had turned into embryos, and three were genetically tested. Two came back healthy and had been frozen.

Her transfer had initially been scheduled for August, but it got canceled when Kirsti contracted COVID-19 that July. Now, as summer turned to fall, Kirsti spent five weeks injecting herself with hormones at their home on the outskirts of Naples, Florida, where she worked as an animal supervisor at the area zoo. Naples sits on Florida’s Gulf Coast, about 40 miles north of the northern edge of the Everglades.

Less than a week out from her transfer, she was at the clinic for a final ultrasound and some blood work when she asked whether she should be worried about a coming storm she had seen on a weather forecast. She remembers the nurse telling her, “We’ll keep an eye on it, but I really wouldn’t worry about it.” At that time, the storm system still looked like it might miss Naples.

By the weekend, though, what had started out as a tropical depression whipped itself into Hurricane Ian, which would turn out to be one of the deadliest and most destructive in U.S. history . 

That Monday, Kirsti and her husband had grown increasingly worried, so they emailed the fertility clinic for an update. While they waited to hear back, they tracked Hurricane Ian on the news, watching as it made its way toward the U.S. “It just kept getting scarier and scarier,” Kirsti said.

On Tuesday, Kirsti went into work and started to evacuate animals from their outdoor enclosures. At this point, the hurricane began to veer toward southwest Florida, but was still expected to make landfall more than a 100 miles north of Naples, sparing her town. That afternoon, calls began to stream in from her parents and her in-laws, who lived along the Florida coast. It was decided that they should take shelter in the couple’s house. By that evening, Kirsti’s two-bedroom, one-bath house was suddenly packed with family and a menagerie of pets. 

On Wednesday morning, Justin injected Kirsti with the last dose of her medication. Southwest Florida was flooding, and parts of the state were losing power , but they hadn’t heard anything from the clinic. Their appointment was supposed to be the next day. As far as Kirsti knew, the procedure was still on track.

Since the beginning of the 2000s, climate change researchers have warned that a warmer planet produces stronger and more damaging hurricanes. In 2020, 30 named storms developed in the Atlantic , setting a record. University of Pennsylvania researchers recently predicted that this year’s Atlantic hurricane season will include 33 named storms . Study after study has demonstrated that the convergence of a warmer, wetter atmosphere and a higher sea-surface temperature causes tropical depressions to grow into hurricanes more quickly. A study published late last year said storms have become twice as likely to develop from a weak tropical cyclone into a Category 3, 4, or 5 hurricane within a 24-hour window — a process meteorologists call “rapid intensification.” The growing intensity of hurricanes has prompted some climate scientists to suggest adding a sixth category to the Saffir-Simpson scale , for hurricanes with winds faster than 192 miles per hour. 

Hurricane Ian was a prime example of a storm charged by climate change. It strengthened from a Category 3 into a Category 4 hurricane in under 24 hours. Ian is just one of several major hurricanes that have struck the southern and southeastern coasts of the United States in the past decade — regions that are particularly vulnerable to damage during the Atlantic hurricane season . In places like Florida, Louisiana, Georgia, Puerto Rico, and Texas, it’s becoming increasingly evident that communities and the infrastructure they rely on are ill-prepared for intensifying storms.

Hurricane Harvey, a Category 4 storm that hit Texas in 2017 , submerged hundreds of roads, collapsed bridges, and damaged more than 300,000 homes. That same year, Category 4 Hurricane Maria decimated Puerto Rico’s aging power grid, plunging the island into darkness for nearly a year — the longest power outage in U.S. history . In 2020, Category 4 Hurricane Laura barreled into southwest Louisiana , displacing thousands of residents and nearly destroying the city of Lake Charles. The city was still clearing wreckage caused by Laura, the most powerful storm to hit southwest Louisiana since record-keeping began, when another hurricane, Category 2 Delta , carved a nearly identical path of destruction through the state. Lake Charles continues to recover four years later.

Fertility clinics are just as vulnerable to storms as any other infrastructure. When Hurricane Ida hit New Orleans in 2021, Nicole Ulrich, a doctor at Audubon Fertility Center, experienced firsthand the challenges intensifying hurricanes pose to these centers. Similar to Hurricane Ian, Ida progressed so rapidly that it caught the city and clinic off guard. 

Forecasters “thought it was maybe going to be a [Category] 1 or a 2, and then it was going to be a 3, and then all of a sudden, it was going to be a 4. At that point, there really should have been a mandatory evacuation, but there wasn’t enough time,” said Ulrich. “We had to close the clinic at that point, because there just wasn’t another option.”

As a result, Audubon had to cancel at least 10 IVF cycles, and delay the start of several others. This included patients who were preparing for embryo transfers, and others who had started injecting the hormones needed for egg retrieval. The clinic also had some embryos growing in the lab. It usually takes five or six days to tell which embryos are healthy and suitable for freezing, but Ulrich’s clinic had to quickly decide to freeze them early, on days two and three instead, just in case their backup power generator failed.

Once the clinic was back up and running, it took months before Ulrich and her team could fit in all the patients whose cycles had been canceled or delayed — patients who were anxiously awaiting the chance to restart the process.

“For most people, waiting a month is not going to make that big of a difference. But when you’re in that moment and you’re 42 and you know your egg count is low, it feels like just the most devastating thing that could happen,” said Ulrich. “There is a chance that, especially when you get closer to 43, it might make a difference.”

The embryos Audubon froze early had to be thawed in order to mature and then refrozen. The clinic is still analyzing data from that change in protocol to understand if it affected pregnancy outcomes.  

Thanks to that experience, Ulrich published a paper in 2022 that calls for more research on the topic of IVF and climate change, with a focus on the particular challenges posed by rapidly intensifying hurricanes. “It had a huge impact on our clinic and our patients, and for months afterwards, we were still dealing with the aftereffects,” she wrote. 

But the experience taught Ulrich lessons other IVF facilities could benefit from. Ulrich said she’d love to see clinics establish better relationships with other fertility treatment centers in their region so that patients could transfer to them in times of disaster. She also encourages clinic staff to review their emergency action plans to ensure they are prepared to meet the changing nature of storms, and to be ready to make decisions quickly to salvage cycles and protect embryos. All clinics store embryos in nitrogen tanks, which do not rely on electricity and are typically safe from blackouts or issues with electrical grids. But the labs that embryos mature in before they are frozen do depend on electricity — and if a disaster takes out power for too long, even backup generators can run out of fuel. During Hurricane Katrina, embryos were lost at one clinic for this reason.

In 13 states, more than half of fertility clinics are at risk of hurricane damage

Share of assisted reproductive technology clinics in areas with “very high,” “relatively high,” or “relatively moderate” hurricane risk

Table displays only states with at least one clinic in a high-risk area. Risk categorized by census tract. Excludes clinics that reorganized or shut down after 2021.

Source : Centers for Disease Control; FEMA National Risk Index

Chart : Jasmine Mithani / The 19th; Clayton Aldern / Grist

IVF clinics are currently not required to have emergency plans in place, but it is recommended by the American Society of Reproductive Medicine. In 2022, the society published its own paper highlighting the need for clinics to adapt to increasingly threatening hurricane seasons. 

“Clearly, climate change means you are having more extreme weather events, and [I] think that, like every other part of society, from homeowners to hospitals, fertility clinics have to think a bit more about how they can build more resilient systems,” said Scott Tipton, chief advocacy and policy officer with the American Society of Reproductive Medicine.

Within a few hours of Kirsti’s final hormone injection, she saw her nurse’s name light up on her phone. Before ducking into her bedroom to get some privacy from the houseguests, she exchanged a despairing glance with Justin. “I just looked at my husband and I was like, ‘It's not happening, it's not happening,’ and I took the phone call.”

The nurse immediately assured her that her embryos were safe but confirmed her suspicion: The clinic was closing because of the storm, and Kirsti wouldn’t be able to go through with the transfer the following day. In fact, they would have to start her cycle all over again. (Kirsti’s clinic did not respond to requests for comment.)

“It just felt like our earth was shattered,” she said. Five weeks of hormone injections had taken their toll on her body, both emotionally and physically. She had grown to dread the shots, which caused swelling in her buttocks, thighs, and stomach. “We had spent so much money, so much time. I was covered in bruises,” she said. “I hung up the phone and I just lost it. I lost it. I wasn’t even angry. I was just heartbroken.” 

Aside from the sadness she felt over yet another hurdle in their fertility journey, Kirsti thought about all the money she and Justin had poured into the treatment, including borrowing from family. The $2,500 the couple had spent on fertility medications that month evaporated the moment Kirsti’s phone rang. If the couple were to restart the embryo transfer process, they would have to spend thousands more. 

The average cost of one cycle of IVF in the U.S. is $12,400 , but prices can vary depending on the clinic, the cocktail of fertility medicines used, and the number of embryos collected and frozen. Some clinics charge as much as $30,000 per cycle . And many patients need more than one cycle to get pregnant.

Because IVF is so costly, there is a large access gap between those who can afford the treatment and those who can’t. In a 2021 survey administered by researchers in Illinois who sought to better understand the demographics of IVF patients in the state , 75.5 percent of the respondents were white, 10.2 percent Asian, 7.3 percent Black, and 5.7 percent Latina. 

Despite these hurdles, IVF is becoming increasingly popular. The treatment allows people to delay pregnancy for any number of reasons — to build a career, save money for a family, or find the right partner. And it’s a crucial tool for people struggling with infertility. In the U.S., that’s 1 in 5 women . 

More than 40 percent of all American adults now say they have used fertility treatments or know someone who has had them, as the number of people who delay childbearing grows. In 1970, the average age of a person giving birth for the first time was 21.4 . In 2021, that average was six years higher .

As IVF has grown more common, it has also become the target of political and legal attacks. In February, Alabama’s Supreme Court, dominated by conservative judges, ruled that embryos created in vitro should be thought of as children for the purposes of wrongful death lawsuits. The ruling had an immediate chilling effect on clinics throughout the state. A month later, Alabama lawmakers extended criminal and civil immunity protections to IVF clinics for their day-to-day operations. Manufacturers of products used in the course of IVF treatment get some immunity protections under the new law, too. But the law still leaves providers at risk because it doesn’t challenge the court’s assertion that embryos are people.  

This decision also has possible implications for doctors practicing IVF when a disaster hits, said Ulrich. “If you had an incubator on a power grid that failed, and you didn't have a backup or the backup failed — those embryos would have been lost,” said Ulrich. Perhaps patients would see the loss as an unavoidable accident — or perhaps they’d sue for wrongful death, she said. “It’s another reason to be careful.”

In the days after Hurricane Ian made landfall, Kirsti spent her time worrying about her family, her neighborhood, her house, and the animals at the zoo. Beneath it all, she felt a deep sense of despair. “I felt like every single piece of me was being hit and like every single thing I had was being ripped to shreds,” she said. But there was no doubt in her mind that she and Justin would try again. 

For months, Kirsti’s embryos stayed safely frozen while she and a few other women she knew from the clinic waited to have their transfers rescheduled. The hurricane’s disruption meant their appointments would come after others already on the books, so she wouldn’t be penciled in until December, delaying her procedure even longer. The clinic agreed to waive the fees for the postponed transfer, but Kirsti and Justin still had to pay out of pocket for the costly medications.

On Halloween, she once again started preparing her body to carry a baby, taking a slew of medications and undergoing daily hormone injections. On the first of December, she completed the long-awaited transfer. Two weeks later, her doctors confirmed what she already knew based on a home test: Kirsti was pregnant. “I was over the moon,” she said.

She was also nervous: “We had been pregnant before and it always ended in loss.” As she and her husband put together the baby’s zoo-themed room they felt hopeful — but nothing was certain until August 8, 2023, when she gave birth to a healthy baby girl named Gracie. 

That day, the Naples coast was hot and sunny. As they looked down at their newborn daughter, Kirsti and Justin reflected on all it took to get there, after nearly four years of trying to start their family. “She was here and in our arms, and we just had this moment,” she said. “It was like, ‘We did it.’”

A few weeks later, Florida was hit by another Category 4 hurricane.

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Vermont passed a bill making Big Oil pay. Now comes the hard part.

Expecting worse: giving birth on a planet in crisis, pregnant in a warming climate: a lethal ‘double risk’ for malaria, salt in the womb: how rising seas erode reproductive health, ‘how did we miss this for so long’: the link between extreme heat and preterm birth, san diego ponders a bid to take over its for-profit energy utility, better late than never: wealthy nations finally meet $100 billion climate aid goal, georgia governor calls for even more nuclear power despite budget woes, grist hires matt simon as senior staff writer, modal gallery.

Get ready: NOAA meteorologists agree it could be ‘extraordinary’ hurricane season

• Max Chesnes Times staff
• Jack Prator Times staff

With the Atlantic Ocean heating to levels normally seen in August, federal meteorologists on Thursday issued their most aggressive preseason hurricane forecast in history.

Storm experts at the National Oceanic and Atmospheric Administration are calling for an “above average” 2024 Atlantic hurricane season with up to 25 named storms, of which as many as 13 could spin into hurricanes and up to seven could muscle to major hurricane status with a Category 3 strength or higher.

It’s not just the warmer-than-usual Atlantic temperatures that forecasters are watching. They also cite an emerging La Niña weather pattern, known to be more friendly to hurricane formation than its counterpart, El Niño, as a main reason this year’s storm season could be busy.

Forecasters predict an 85% probability of an above-average season — the most confidence the agency has had in a storm outlook.

“The key this year, as in any year, is to get prepared and stay prepared,” said Rick Spinrad, the head of the agency. He noted the start of what could be an “extraordinary” season is June 1, just days away.

The federal forecast comes on the heels of some of the most ambitious hurricane season outlooks ever produced by renowned climate schools. Last month, Colorado State University issued an early outlook that calls for 11 hurricanes — the most that university has ever predicted.

A few weeks later, the University of Pennsylvania revealed an aggressive forecast of their own: Experts there anticipate a record 33 named storms. Those predictions also pointed to warming Atlantic temperatures and an emerging La Niña weather pattern.

“The ocean is already in the heart of hurricane season. It’s three months ahead of pace,” said Brian McNoldy, a senior research associate at the University of Miami. “I’m hoping things go back to normal soon, but I’m not going to hold my breath.”

There's been a lot of attention on Atlantic ocean temperatures, which there should be! What we're seeing is absolutely stunning. The "Main Development Region" SST is as warm as it normally would be in mid-August, and in terms of ocean heat content, it looks like early August. pic.twitter.com/qyyH4tPobr — Brian McNoldy (@BMcNoldy) May 15, 2024

Waters stretching between the Caribbean and the coast of Africa are at record-hot levels, with more than 90% of the region’s sea surface at record or near-record heat, according to Michael Lowry, a hurricane specialist at WPLG-TV. Human-driven climate change and the quickly developing shift to a La Niña are two of the likely several factors for why Atlantic waters are hotter now than at any point on record this early in the season, according to Lowry.

The aggressive forecast didn’t surprise Jeff Masters, a hurricane scientist formerly with the National Oceanic and Atmospheric Administration. Given the record ocean heat and the dissipating El Niño, this season already has all the ingredients for tumultuous weather.

“It’s probably going to be a crazy-active season,” Masters said. Winds will likely help nudge hurricanes to form, and it’s looking like there won’t be as many shearing winds that can tear storms apart, he said.

Rapid intensification, which occurs when a storm’s top wind speeds rise by 35 mph in a single day, is tied closely to ocean temperatures, experts said. Ken Graham, director of the National Weather Service, said the strongest storms over the last century have all been fueled by rapid intensification.

“I worry about that every season,” Graham said.

Colorado State University in early April identified five similar Atlantic hurricane seasons from over the centuries that resemble the start of this year’s season: 1878, 1926, 1998, 2010 and 2020. Records are spotty from the late 19th century going into the early 20th century, but experts at the university said those were all active seasons.

In 2010, most of the United States was largely spared, but it was a relatively busy season. The world saw the most active hurricane season to date in 2020, with 30 named storms, of which 14 became hurricanes, including seven major hurricanes. A record 12 named storms made landfall across the United States that year.

If it does end up being an active season, that doesn’t guarantee that a hurricane will hit where you live — but it does increase the odds, McNoldy said.

For instance: Forecasters at Colorado State University predicted a greater than 50% probability that a named storm will stray within 50 miles of Hillsborough and Pinellas counties this season. The probability for winds or rains brought by a hurricane hover above 25% locally, and there’s an 11% probability for a major hurricane to hit the Tampa Bay area, according to the university.

This week, St. Petersburg Mayor Ken Welch and 12 other Pinellas mayors penned a letter to Washington asking for more storm-hardening funds. The coastal mayors wrote that grants provided by the Federal Emergency Management Agency are “woefully underfunded” and urged the agency to prioritize its resilience programs for local governments.

“We are not seeking a handout but rather a partnership in protecting our communities,” the letter states.

Forecasters are already watching a patch of disturbed weather.

Just two hours before NOAA issued its season outlook, the National Hurricane Center said it was tracking a “large area of cloudiness and showers” east of Cuba. There is just a 10% chance it forms into a tropical system over the next week, forecasters said.

“You hear the same thing every year: ‘It only takes one storm.’ But it’s true,” Masters said. “You should make the same preparations assuming you’re going to get a worst-case storm. Review your evacuation plan, get flood insurance if you can afford it, flood-proof your home.”

Remember Hurricane Katrina?🌀 That was 2005. 2024 will be a year to remember! https://t.co/aTuA5mAXFU pic.twitter.com/ule4Y8BAsz — Leon Simons (@LeonSimons8) May 22, 2024

Max Chesnes is an environment and climate reporter, covering water quality, environmental justice and wildlife. Reach him at [email protected].

Jack Prator is a reporter covering breaking news and environment. Reach him at [email protected].

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