Caillouet L Philip, Paul P Joseph, Sabatier Steven M, Caillouet Kevin A
Louisiana Center Health Informatics, University of Louisiana at Lafayette, USA.
Am J Disaster Med. 2012 Fall;7(4):253-71. doi: 10.5055/ajdm.2012.0099.
The objective of this study is to gain insight into the medical needs of disaster evacuees, through a review of experiential data collected in evacuation shelters in the days and weeks following Hurricanes Katrina and Rita in 2005, to better prepare for similar events in the future. Armed with the information and insights provided herein, it is hoped that meaningful precautions and decisive actions can be taken by individuals, families, institutions, communities, and officials should the Louisiana Gulf Coast-or any other area with well-known vulnerabilities-be faced with a future emergency.
Demographic and clinical data that were recorded on paper documents during triage and treatment in evacuation shelters were later transcribed into a computerized database management system, with cooperation of the Department of Health Information Management at The University of Louisiana at Lafayette. Analysis of those contemporaneously collected data was undertaken later by the Louisiana Center for Health Informatics.
Evacuation shelters, Parish Health Units, and other locations including churches and community centers were the venue for ad hoc clinics in the Acadiana region of Louisiana.
PATIENTS, PARTICIPANTS: The evacuee-patients-3,329 of them-whose information is reflected in the subject dataset were among two geographically distinct but similarly distressed groups: 1) evacuees from Hurricane Katrina that devastated New Orleans and other locales near Louisiana and neighboring states in late August 2005 and 2) evacuees from Hurricane Rita that devastated Southwest Louisiana and neighboring areas of Texas in September 2005. Patient data were collected by physicians, nurses, and other volunteers associated with the Operation Minnesota Lifeline (OML) deployment during the weeks following the events.
Volunteer clinicians from OML provided triage and treatment services and documented those services as paper medical records. As the focus of the OML "mission of mercy" was entirely on direct individually specific evaluation and care, no population-based experimental hypothesis was framed nor was the effectiveness of any specific intervention researched at the time.
MAIN OUTCOME MEASURE(S): This study reports experiential data collected without a particular preconceived hypothesis, because no specific outcome measures had been designed in advance.
Data analysis revealed much about the origins and demographics of the evacuees, their hurricane-related risks and injuries, and the loss of continuity in their prior and ongoing healthcare.
The authors believe that much can be learned from studying data collected in evacuee triage clinics, and that such insights may influence personal and official preparedness for future events. In the Katrina-Rita evacuations, only paper-based data collection mechanisms were used-and those with great inconsistency-and there was no predeployed mechanism for close-to-real-time collation of evacuee data. Deployment of simple electronic health record systems might well have allowed for a better real-time understanding of the unfolding of events, upon arrival of evacuees in shelters. Information and communication technologies have advanced since 2005, but predisaster staging and training on such technologies is still lacking.
本研究的目的是通过回顾2005年卡特里娜飓风和丽塔飓风过后数天及数周内在疏散避难所收集的经验数据，深入了解灾难撤离者的医疗需求，以便为未来类似事件做好更充分的准备。希望个人、家庭、机构、社区和官员能够利用本文提供的信息和见解，在路易斯安那州墨西哥湾沿岸地区——或任何其他存在明显脆弱性的地区——未来面临紧急情况时，采取有意义的预防措施并果断行动。
在疏散避难所进行分诊和治疗期间记录在纸质文件上的人口统计学和临床数据，后来在路易斯安那大学拉斐特分校健康信息管理系的合作下，被转录到一个计算机化数据库管理系统中。路易斯安那州健康信息学中心随后对这些同期收集的数据进行了分析。
疏散避难所、教区卫生单位以及包括教堂和社区中心在内的其他地点，是路易斯安那州阿卡迪亚地区临时诊所的场所。
患者、参与者：其信息反映在主题数据集中的3329名撤离者患者，来自两个地理位置不同但同样受灾严重的群体：1）2005年8月下旬卡特里娜飓风的撤离者，该飓风摧毁了新奥尔良以及路易斯安那州附近和邻近州的其他地区；2）2005年9月丽塔飓风的撤离者，该飓风摧毁了路易斯安那州西南部和得克萨斯州邻近地区。事件发生后的几周内，与明尼苏达生命线行动（OML）部署相关的医生、护士和其他志愿者收集了患者数据。
OML的志愿临床医生提供分诊和治疗服务，并将这些服务记录为纸质病历。由于OML“慈悲使命”的重点完全在于直接针对个体的具体评估和护理，当时没有形成基于人群的实验假设，也没有研究任何特定干预措施的有效性。
本研究报告了在没有特定先入为主假设的情况下收集的经验数据，因为事先没有设计具体的观察指标。
数据分析揭示了撤离者的来源和人口统计学特征、与飓风相关的风险和伤害，以及他们先前和正在进行的医疗保健的连续性中断情况。
作者认为，通过研究在撤离者分诊诊所收集的数据可以学到很多东西，这些见解可能会影响个人和官方对未来事件的准备。在卡特里娜 - 丽塔飓风疏散过程中，仅使用了基于纸质的数据收集机制，而且这些机制存在很大的不一致性，并且没有预先部署的机制用于对撤离者数据进行近乎实时的整理。部署简单的电子健康记录系统很可能会使人们在撤离者抵达避难所时，能够更好地实时了解事件的发展情况。自2005年以来，信息和通信技术已经取得了进步，但在这些技术的灾前准备和培训方面仍然不足。
