Katrina: an introduction

Professor JB BuryInaugural lecture as Regius Professor of Modern HistoryUniversity of Cambridge, 1903The Gulf Coast Disaster of September 2005 has changed the entire paradigm of how we view public health. Our previous visions of disaster relief were predicated on the premise that the most effective after care would involve treating the direct effects of catastrophic, unpredicted trauma. Survivors would be readily amenable to first aid at the scene, followed by evacuation from the area. Involved hospitals and care stations had tables of organization to manage disasters and held regular drills to ensure familiarity with them. Organizational routes to import volunteers were planned years in advance. It was thought that the aftermath of a natural disaster would be quelled in direct proportion to the amount of effort put into direct action at the scene.From a historical perspective, there were some major differences between other recent calamities and the Gulf Coast disaster. On 7 December 1988, a severe earthquake struck Armenia, a small country in the former republic of the Soviet Union [1]. The quake, lasting 20 s, was estimated to be as destructive as 120 atomic bombs, destroying 21 towns and 302 villages in seconds. It killed 25,000 people, injured 19,000, and rendered 540,000 homeless [2]. Following the quake, virtually every public service, including water, electricity, transport, fire rescue, and health care, was either destroyed or damaged beyond use. All communication became unreliable. However, considering the circumstances, the local public services' response to the injured was rapid and reasonably effective. Rescuers maximized whatever facilities were available, set up first aid centers, triaged patients, and transported the injured back to areas outside the immediate damage area however possible. They were content to do what we could with what they had, and the outcome seemed as good as could be expected. The basic paradigm of disaster care changed little.O