Direct patient care during an acute disaster: chasing the will-o'-the-wisp

On 29 August 2005, Hurricane Katrina made landfall along the coasts of Mississippi and Louisiana. The entire Gulf Coast incurred extensive damage from this powerful category 4 hurricane. At the time of writing, more than 1000 individuals in the path of this hurricane have been reported dead. At least 200 deaths occurred along the Mississippi coast. In addition, innumerable coastal residents have been permanently displaced secondary to catastrophic damage to their homes.Ocean Springs Hospital is a 135-bed hospital on the Mississippi Gulf Coast. Ocean Springs, which lies east of Biloxi, incurred significant damage during the storm. However, the hospital sustained only minor damage and was operational during and after the storm. The five hospitals in the adjacent two western counties sustained more significant damage and operated at limited capacities. Subsequently, Ocean Springs Hospital became the primary health provider for a large section of the affected population along the Gulf Coast. In spite of a well developed disaster plan that had been put to test a number of times previously in this hurricane prone area, we faced a number of unanticipated problems. This is an account of some of these problems and the steps taken to combat them at the level of a community hospital.The hospital was staffed by a group of physicians and nurses who comprised the 'Hurricane team'. This group of physicians, nurses, and ancillary staff is required to be in the hospital at least 12 hours before a predicted hurricane landfall. The hospital is subsequently secured and 'locked down' at this point. Under normal circumstances, this call team would be released within 24–48 hours after hurricane landfall. However, given the extensive damage to the surrounding community and the large number of staff members that evacuated, many relief nurses and physicians were not immediately available. Subsequently, many nurses and physicians were required to provide extended periods of in-house care with