What may be called “disaster science” is a broad field that begins with  understanding hazards, risks, and population vulnerabilities and moves on to establishing best-practice models of response, mitigation, and recovery. Gaps abound in our collective knowledge in all of these areas, and it is fair to suggest that we have only begun to scratch the surface in terms of what we need to know. The goal continues to be to learn how to prevent disasters whenever possible and, when prevention is not possible, to at least optimize survival, preserve vital infrastructure, and return rapidly to a state of normalcy

Abramson, David M.

Redlener, Irwin E.

Disaster Medicine and Public Health Preparedness

Columbia University Academic Commons

EDITORIALRecoveryResearch,Katrina’sFifthAnniversary,and Lessons RelearnedIrwin Redlener, MD; David M. Abramson, PhD, MPH, Guest EditorsThe impulse to understand how people and places re-cover from catastrophic disasters is not new. In Decem-ber 1917 in the throes of World War I, 2 ships acciden-tally collided in Halifax Harbor off Nova Scotia, Canada: one aBelgian ship loaded with relief supplies and the other a Frenchship carrying highly volatile compounds: picric acid, TNT, guncotton, and benzol. The resulting explosionwas characterized asequivalent to a 2.9-kton bomb. It demolished a 2-kmharbor area,precipitated a tsunami that destroyed a Native American en-campment, and ultimately killed more than 2000 people—onefifth of the city’s population—and injuredmore than 9000.1 Thescope and magnitude of Halifax’s devastation was compared atthe time to that of the 1906 San Francisco earthquake and fire.An early witness to the relief and recovery efforts was a youngdoctoral student, Samuel Prince, whose 1920 dissertation “Ca-tastrophe and Social Change” is regarded bymost scholars as thefirst formal piece of disaster research. In it, Prince writes aboutHalifax’s rehabilitation, and about recovery in general: “Disaster-stricken communities cannot becomenormal until the social sur-plus is restored.”2 Prince’s key point was that recovery was notmerely about the reconstruction of bricks andmortar, but ratherabout the social surplus, the restoration of the physiological, so-cial, and socioeconomic resources of a place and its people be-yond that consumed in the disaster.Ninety years later we are still learning that lesson, and one thatwe return to in this special issue ofDisaster Medicine and PublicHealth Preparedness (DMPHP). What may be called “disasterscience” is a broad field that begins with understanding haz-ards, risks, and population vulnerabilities and moves on to es-tablishing best-practice models of response, mitigation, and re-covery. Gaps abound in our collective knowledge in all of theseareas, and it is fair to suggest that we have only begun to scratchthe surface in terms of what we need to know. The goal con-tinues to be to learn how to prevent disasters whenever pos-sible and, when prevention is not possible, to at least optimizesurvival, preserve vital infrastructure, and return rapidly to astate of normalcy.Besides the obvious focus on evidence-based practices in disas-termitigation andmanagement, there aremore conceptual con-structs and theoretical concepts that must underpin progress indisaster response. For instance, we need a far deeper understand-ing of how complex systems interact and affect outcomes withrespect to successful disaster response. Only a greater compre-hension of how population preconditions, such as poverty, in-capacity, or marginalization, will permit improved manage-ment of vulnerable populations before, during, and after disasters.The focus of this supplement ofDMPHP is on recovery, an areaof disaster science that, some would argue, is the least-understood issue in terms of disaster planning. We know thisbecause the history of megadisaster recovery simply does notsuggest that this last phase of disaster response is well under-stood, effectively practiced, or otherwise successful formany com-munities that have been in harm’s way in large-scale disasters,irrespective of their causes.The 5-year mark following the massive impact of HurricanesKatrina and Rita and the flooding of New Orleans was be-lieved to be a good place on the disaster timeline to pause andreflect. Clearly, there are many unprecedented aspects to theevents of late summer 2005.Katrina affected some100 000miles2of the Gulf Coast region (compared to, say, 300miles2of SouthFlorida damaged by Hurricane Andrew in 1992). No large UScity has experienced as great an impact as had New Orleanssince San Francisco in the 1906 earthquake. Still, there are com-monalities shared with catastrophes in Haiti, Kashmir, China,and other unfortunate disaster-impact regions worldwide. Butthe questions remain:Where are we now with respect to disas-ter recovery? What have we learned?As is pointed out in several of the articles in this issue, we knowthat 5 years post-Katrina theGulf region is still in recovery fromthe ravages of the hurricanes and flooding. In the New Or-leans metropolitan area, 20% of the population has not re-turned and the health care system remains troubled and far fromrecovered. Although the New Orleans school system is mak-ing great strides, perhaps surpassing the accessibility to and qual-ity of education before the storms, thousands of children andfamilies continue to live in states of uncertainty and instabil-ity with respect to housing. Peek and Richardson reflect uponthe aspects of educational systems that facilitated recovery amonga displaced pediatric Katrina population, and the critical rolesplayed by parents and schools in addressing such “educationalvulnerability.”3A number of the articles in this special issue address the clini-cal outcomes of disaster exposure among specific vulnerable orat-risk populations: pregnant women,4 people with diabetes,5and residents of nursing facilities.6 Cumulatively, these re-search articles speak to the need for strong, redundant systemsof care that can support these populations and their health careneeds. Other articles in this issue consider 2 specific work-forces that are critical to the operations of such systems: publichealth workers7 and medical residents.8 The National Re-sponse Framework, in particular, has galvanized the public healthS8 Disaster Medicine and Public Health Preparedness VOL. 4/ SUPPL. 1(Reprinted) ©2010 American Medical Association. All rights reserved.workforce to adopt more of a first responder role in disasters,andMcKibben et al7 highlight the long-term effects such a rolemay have on aworkforce that is generally unaccustomed to suchstressors. This is noteworthy given the instrumental role thatgovernmental public health plays in the reconstruction of a com-munity—ensuring that surveillance and regulatory mecha-nisms have been reinstated, that health care for vulnerable popu-lations is ensured, and that preventive services are againavailable.Most concerning, perhaps, has been the unpredicted occur-rence of anothermajor catastrophic event in a region still strug-gling to recover. The undersea oil gusher from the deadly fail-ure of the Deepwater Horizon/BP rig spilled oil and gas into thefragile ecology and economy of theGulf for almost 3 full monthsbefore finally being contained in late July 2010.One could imag-ine that much of the economic and psychological damage hadalready been done.Concern levels remain high because too littleis known about the short- and long-term human health con-sequences of oil and chemical dispersants deployed at the heightof the crisis. Parents and children still recovering from Katrinaare now facing a new disaster, one that could seriously com-promise their recovery from the last trauma.Improving our capacity to recover from large disasters is com-plicated but vitally important. Enhancing the resiliency of in-dividuals, communities, and the nation is, in part, dependenton how rapidly and fully we can recover from serious trauma.And, as we have suggested, the longer and more dysfunctionalthe recovery process, the more likely vulnerable families willexperience consequences well into the future. The practical re-ality is that if policies are not influenced by evidence and les-sons from past experience are not incorporated into planningfor future events, then the process of disaster recovery is leftto whim, anecdote, and the vagaries of political and economicpressures.We also recognize that recovery is a complex task that in-volves and crosses over many disciplines that do not generallycommunicate, much less plan and strategize together. Full re-covery of a community postdisaster to normal or “new nor-mal” conditions lends itself to insights from many sectors anddisciplines: health care, public health, social sciences, engi-neering, urban planning, operational research, communica-tions, public administration, and public policy. Each of thesedisciplines brings perspective and methodologies to the recov-ery table; all of them need to be integrated in new ways.This special issue has attempted to reflect these principles. In-vited authors do present a variety of perspectives, drawing con-clusions and suggesting strategies that would improve recov-ery planning and implementation, nomatter what the disaster.Much as wewould prefer that we never again experience a cata-strophic event, this can never be the case. Natural disasters,pandemics, and terrorism are inevitable, but poor planning, fail-ure to understand essential principles, and a persistent inabil-ity to learn from the past are not intractable realities. It is hopedthat this special issue helps provide a roadmap to improvingour resiliency and capacity to effectively rebuild after any ma-jor disaster.The journal is exceedingly grateful to the Irene W. and C.B.Pennington Family Foundation of Baton Rouge, Louisiana, fortheir generous support of this special issue of DMPHP. Theyhave played a leadership role in inspiring other regional andcommunity foundations to support humanitarian relief and re-covery in theGulf Coast. The Foundation’s commitment to re-covery is underscored here by the importance of understand-ing what accelerates recovery and what impedes it. This issueof the journal is not intended as a “closing of the book” on Ka-trina, but rather a further step in understanding the clinical andsocial implications of catastrophes, how we survive them, andmost importantly, how we can come back strong.Authors’ Affiliations: The authors are with the National Center for DisasterPreparedness, Columbia University.Correspondence: Address correspondence and reprint requests to Dr IrwinRedlener, National Center for Disaster Preparedness, Mailman School of Pub-lic Health, Columbia University, 215 W 125th St, New York, NY 10027 (e-mail: ir2110@columbia.edu).Received for publication: Received for publication July 23, 2010; acceptedJuly 28, 2010.Authors’ Disclosures: The authors report no conflicts of interest.REFERENCES1. Dynes RR, Quarantelli EL. The Place of the 1917 Explosion in Halifax Harborin theHistory ofDisaster Research: TheWork of SamuelH. Prince.Newark:Uni-versity of Delaware Disaster Research Center; 1992.2. Prince SH. Catastrophe and Social Change, Based Upon a Sociological Studyof the Halifax Disaster. New York: Columbia University Press; 1920.3. Peek L, Richardson K. In their own words: displaced children’s educa-tional recovery needs after Hurricane Katrina. Disaster Med Public HealthPrep. 2010;4(Suppl 1):S63-S70.4. Harville EW, Tran T, Xiong X, Buekens P. Population changes, racial/ethnic disparities, and birth outcomes in Louisiana after Hurricane Ka-trina. Disaster Med Public Health Prep. 2010;4(Suppl 1):S39-S45.5. Thethi TK, Yau CL, Shi L, et al. Time to recovery in diabetes and comor-bidities followingHurricane Katrina.Disaster Med Public Health Prep. 2010;4(Suppl 1):S33-S38.6. Dosa D, Feng Z, Hyer K, Brown LM, Thomas K, Mor V. Effects of Hurri-caneKatrina onnursing facility residentmortality, hospitalizations, and func-tional decline. Disaster Med Public Health Prep. 2010;4(Suppl 1):S28-S32.7. McKibben J, Fullerton CS, Ursano RJ, et al. Sleep and arousal as risk fac-tors for adverse health and work performance in public health workers in-volved in the 2004 Florida hurricane season.DisasterMed Public Health Prep.2010;4(Suppl 1):S55-S62.8. Donini-Lenhoff FG,Rockey PH, Surdyk PM,Heard JK, Blackwell TA. Emer-gency preparedness for residency/fellowship programs: Lessons learned dur-ing Hurricane Katrina and applied during Hurricane Ike.Disaster Med Pub-lic Health Prep. 2010;4(Suppl 1):S71-S74.EditorialDisaster Medicine and Public Health Preparedness S9(Reprinted) ©2010 American Medical Association. All rights reserved.

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