The public health response to disasters in the 21st Century: reflections on Hurricane Katrina.

* In the last decade, America has experienced many public health advances related to disaster preparedness.

* So what went wrong with the Hurricane Katrina disaster?

* Also, what may have gone right with the public health response to this event?

* Prior to landfall of Hurricane Katrina, major evacuation steps were taken to move susceptible populations from high-risk areas.

* Nevertheless, many people did not or could not evacuate.

* In the first three or four days following impact, those who had not evacuated the flooded areas required basic care, support, and protection.

* Most victims did not receive this support.

* As a result, many people died unnecessarily.

* Those who did not die experienced undue hardships.

* Hurricane Katrina was responsible for more than 1,300 deaths

* It may not be the direct role of public health professionals to rescue victims from rooftops or to deliver food or clean water.

* But it is their role to

-- "monitor health status to identify and solve community health problems";

-- "diagnose and investigate health problems and health hazards in the community";

-- "inform, educate, and empower people about health issues"; and

-- "mobilize community partnerships and action to identify and solve health problems."

* These are the first four of the 10 essential public health services outlined by the Centers for Disease Control and Prevention (CDC) in 1994.

* As part of the public health role in disaster preparedness, key public health leaders should be clearly designated.

* These leaders should be responsible for coordinating all public health responses, including public health communications.

* After Hurricane Katrina, both CDC and state and local public health agencies participated in workforce deployments to affected communities.

* For instance, the Bureau of Emergency Medical Services of the Pennsylvania Department of Health coordinated the deployment of emergency medical services from Pennsylvania to Louisiana.

* These and other agencies also provided written advisories and recommendations to the public.

* They initiated follow-up steps on a number of public health issues, including

-- prevention of environmental health conditions such as carbon monoxide poisoning,

-- mosquito control,

-- prevention of accidents and injuries for those returning to the affected areas,

-- immunization efforts and other actions taken to prevent the spread of infectious diseases, and

-- surveillance efforts related to disease, the environment, accidents and injuries, and mental health.

* Disasters represent a major national environmental hazard and a predictable recurring problem.

* So it may be the right time to consider the creation of a special CDC center or other unit within the Department of Health and Human Services that is exclusively dedicated to disasters and public health.

* Such a unit would be the primary focal point for the public health response to disasters at the national level.

* A new center should be comprehensive in its organization and include all pertinent areas of public health, such as

-- medicine,

-- environmental health,

-- epidemiology,

-- communications,

-- emergency response, and

-- emergency medical services.

* The model used to design the Agency for Toxic Substances and Disease Registry (ATSDR) should be considered because of the success of that agency.

This department, Practical Stuff! originated from you, our readers. Many of you have expressed to us that one of the main reasons you read the Journal of Environmental Health is to glean practical and useful information for your everyday work-related activities. In response to your feedback, we dedicate this section to you with salient points to remember about two to three articles in each issue.