1. Mason, Diana J. PhD, RN, FAAN, AJN Editor-in-Chief

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I write this the day after Labor Day. Bodies float in a flooded and contaminated New Orleans; the Gulf region's most vulnerable citizens-nursing home residents, premature infants, the homeless, the mentally ill, the poor-are without food, water, shelter, safety, and trust, or they are dying or dead; federal leaders hastily call news conferences under harsh criticism of their inept response; and many Americans have been moved to ask, What can we learn from this disaster turned debacle? I believe that we can and must learn something from it.


Prevention is the heart of public health.

While nothing could be done to prevent the hurricane, the flooding of New Orleans was avoidable. In 2004 and 2005, the New Orleans Times-Picayune published a series of articles about the lack of federal dollars allocated to shore up the Lake Pontchartrain levee that the government's own Army Corps of Engineers said could be breached by a storm of Katrina's ferocity. The funding to shore up a sinking levee was slashed after 2003, as federal funds were being diverted to the Department of Homeland Security and the war in Iraq. As a consequence, the New Orleans flooding led to deaths by drowning or starvation or the lack of access to medical care. Contaminated water, infected wounds, and traumas of all kinds debilitated countless people along the Gulf Coast.


Preparedness is essential.

Nurses know that command, control, and coordination during a disaster must be reliable and tested. In New York City after September 11, 2001, billions of dollars were poured into "biopreparedness," but the basic communications infrastructure and the question of how hospitals would function without electricity or when extremely debilitated weren't adequately addressed. What is apparent at this writing is that public officials were days too slow in responding, had inadequate command of the situation, and coordinated emergency response poorly, compounding the devastation.

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An analysis of the failings of the Department of Homeland Security, specifically, and the responses of the local, state, and federal governments are in order and must include the Department of Health and Human Services.


Disparities are real.

The country's racial and class divide screamed out in reports of the poor, mostly African American people stranded in New Orleans. These most vulnerable of people were and will continue to be disproportionately affected by the disaster. Hospitals that served the poor didn't have helicopters to evacuate patients quickly and safely. Exposure to water contaminated with infectious agents and heavy metals, limited access to essential medications, and other serious threats to the health of those who remained in the city are likely to exacerbate disparities. How long will we-nurses and our nation-continue to tolerate this injustice?


You can count on nurses.

Nurses were among the heroes of this disaster. The media covered stories of nurses hand ventilating patients who had been on respirators until electricity was lost, triaging sick and injured victims under previously unthinkable circumstances, reuniting newborns with parents after evacuations had separated them, working around the clock when replacements couldn't get to hospitals or nursing homes or shelters (see page 19, page 37, and page 102).


These nurses didn't have to be forced to work overtime. They saw the need and responded to an emergency. The federal government and every state should immediately pass legislation outlawing mandatory overtime in honor of the nurses who gladly stayed on the job during this crisis. The predominant argument against such legislation has been that institutions still need the authority to force nurses to work during real emergencies. It's an empty, false argument.


Some will say that a force called Katrina was responsible for thousands of lost lives and unimaginable devastation. And she was. But the impact of her fury could have been lessened by an informed, coordinated response from all levels of government.