The response to Hurricane Katrina: Iowa's interstate cooperation and lessons learned.

Environmental public health practitioners play an important role in the protection of public health. Every day we conduct inspections and provide education to prevent foodborne, waterborne, and airborne illnesses. Responding to emergencies requires these same skills, coupled with emergency response protocols and procedures. From September 3 to September 18, 2005, through an emergency management assistance compact (EMAC) agreement, six environmental public health professionals from the Iowa Environmental Health Emergency Response Team (EHRT) were deployed to Louisiana. The response was coordinated through Iowa and Louisiana Homeland Security and Emergency Management, with the mission of working directly with the Louisiana Department of Health and Hospitals (LDHH).

Upon arrival, the Iowa team, who were the first state environmental resource to arrive in Baton Rouge through an EMAC agreement, met with representatives of LDHH, the Louisiana Rural Water Association, and the U.S. Environmental Protection Agency (U.S. EPA) Region 6 to develop a strategy for addressing the many environmental health concerns in Louisiana. Food safety and protection of public and private water supplies were the top priorities identified by Louisiana Environmental Health Services Director Bobby Savoie. We immediately began conducting water sampling and commercial seafood and retail food establishment assessments and inspections in the affected parishes of St. Tammany, Washington, Jefferson, and Orleans.

We quickly learned that in addition to the food and water quality concerns that resulted from hurricane damage, there were also health and sanitation issues at shelters for victims and responders that were not being adequately addressed. Inspection of mass shelter facilities quickly became a critical environmental health function. The high volunteer turnover rate in mass shelters and the overflowing volume of victims created big problems for New Orleans and rural Louisiana. Through daily inspections, the team encouraged shelter managers and workers to engage in sound environmental public health practices. The available workforce had large gaps throughout the Gulf Coast, and it was also quickly recognized that the local environmental health workforce who lived in the affected areas were often not able to respond quickly because of personal response needs.

Often of greatest help during response efforts are local contacts who may not be part of the official response effort. Church groups, local business, and other private organizations can help fill that role. As a response partner, environmental health staff must recognize that these other resources are equally vital in an effective response effort.

As with almost every emergency response effort, communication and disaster planning were recognized as the weakest components. After experiencing firsthand some of the frustrations associated with Hurricane Katrina at the local, state, and even federal levels, we knew that the issue all environmental public health must first address is the presence of a prepared workforce during local emergencies and disasters. Does this happen overnight? The answer is no!

In 2003, the Iowa Department of Public Health decided to form an EHRT that would function as a statewide asset during local emergencies while developing the capacity to respond to natural disasters and terrorism events. The Iowa Department of Public Health response team concept includes the EHRT as one of three legs of our public health response stool: The other two legs are a Disaster Medical Assistance Team and an Epidemiology Response Team. The goal of the Iowa Department of Public Health is to provide a resource for our emergency management counterparts when responding to public health disasters if resources become depleted. The chief advantage of having a team of environmental public health professionals is the capacity to respond to an array of environmental public health issues. The creation of an EHRT can be duplicated or enhanced across the nation so that more local entities can become better prepared and self-reliant.

The experiences in Louisiana that we shared have also influenced emergency-planning efforts across Iowa. Currently, references to environmental health response actions are scattered throughout the Iowa Emergency Response Plan. We are working on creating one document that emergency response personnel can easily access to learn about the role of environmental public health. We have also asked local environmental public health jurisdictions to create their own response plans and to work with emergency managers to incorporate those response plans into their multihazard plans.

It is important to avoid making planning mistakes that could become operational response nightmares and derail a quick, educated, and feasible response to the public health emergencies that inevitably will affect the rural cornfields and urban settings of Iowa. The biggest mistake environmental public health practitioners can make is not getting involved with emergency response planning efforts.

I challenge each and every member of NEHA to form response partnerships with other entities in local government and private business. Create an atmosphere in which environmental health is fostered and nurtured as an essential response partner. Creating these partnerships enhances the protection of water, food, and air quality that affects public health not only during emergencies, but also every time we step into action to protect public health. Build capacity where there is none by creating a prepared environmental public health workforce with field-ready responders. Each of us must realize that the response table is set, and as essential responders in the post-Katrina era, we must take a seat along with other emergency responders.

Corresponding Author: Cory Frank, Environmental Health Response Team Coordinator, Community Health Consultant, Iowa Department of Public Health, Division of Environmental Health, Lucas State Office Building, 321 E. 12th Street, Des Moines, IA 50319-0075. E-mail: [e-mail].