The concept of establishing increased capacity to meet the surge in disaster victims' healthcare needs has been well established among medical and planning professionals and passed an acid test during this season's Gulf Coast hurricanes. Less well established, however, is an understanding of how community infrastructures will have to be modified to keep pace with those surge facilities, says a Texas A&M University health-planning professor.

“Much work has been done on the infrastructure needs of cities, because they are more vulnerable to both natural and terrorist threats,” says Sherry Bame, a professor of urban planning affiliated with the College of Architecture’s Hazards Reduction and Recovery Center. “Less attention has been paid to how well prepared smaller communities are to take the surge of evacuees and disaster victims streaming out of the urban areas. Planners in such areas need to figure out how they will accommodate a sudden influx of people that can increase the community's population by as much as 20 to 40 percent.”

Texas A&M's home base at College Station faced just such a influx during the evacuations caused by hurricanes Katrina and Rita impacting the Gulf Coast.

“Last semester, my students and I studied the evacuation impacts on our community, interviewing evacuees and emergency personnel and volunteering at the various surge facilities that were set up here,” Bame says. “During the period immediately before and after these hurricanes, we estimate that the Bryan-College Station area sheltered over 13,000 people, a surge of almost 10 percent of the local population. These evacuees were provided with food, clothing and emergency care, and most of them are now getting on with their lives. In addition, an unknown number were housed with friends or family. But what comes next? What is the impact on the receiving community itself.”

Work by Bame and colleagues in the area of emergency response suggests that community's infrastructures — water supplies, sewage disposal facilities, roads — will need to be prepared to accommodate surge facilities planned for the future. Water system managers, wastewater disposal managers, directors of emergency operations centers and directors responsible for other disaster services need to turn their attention to infrastructure planning well in advance of disasters, Bame notes.

“Professionals in these fields need to recognize differences when dealing with patient populations that will be housed in such surge facilities,” she says. “Hospitals need to plan facilities that will be able to take in the surge of inpatients, including planning for power generators, medical supplies and adequate staff. Hospitals also need to look at their capacities for outreach, treating people in facilities other than the emergency room. And healthcare providers need to assess the potential needs of special populations like hospice or nursing home patients, the disabled and residents of shelters, such as those for abused women and children.

“Many disabled persons can function just fine in their own familiar surroundings, where they have their regular medicines and special appliances handy,” Bame says, “but when they have to evacuate, they may be rendered unable to care for themselves in their new environment.”

All these factors — facilities design, infrastructure upgrades, patient population needs — must be taken into account when crafting decision-making strategies and procedures, Bame notes.

“It's especially crucial that we take these steps as we head into a new hurricane season,” she says.