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Louisiana suffered the impact of two hurricanes: Hurricane Isaac in August 2012 and Hurricane Harvey in August-September 2017.  Both events resulted in the opening of the State Emergency Shelter (aka the “Megashelter”) in Alexandria, Louisiana.  This paper compares the two events, which prompted the activation of Louisiana’s emergency response, and explains the reasons for their success.

As a bit of background, the Megashelter was funded with FEMA dollars in the aftermath of Hurricane Katrina (2005).  It was conceived and designed specifically as an evacuation center, one of three such proposed sites: Alexandria, Monroe and Shreveport.  Eventually, only the Alexandria site saw the light of day, being completed in 2010.  The 200,000 square foot facility, designed specifically as shelter, is divided into a much larger space for critical transportation needs (CTNS) evacuees and a smaller segment for medical special needs clients (MSNS).  The CTNS section can accommodate 2,500 evacuees and the MSNS side can house up to 500 clients or more depending on its configuration.  A mezzanine contains a security office, storage, billeting for 88 staff and a catwalk allowing direct observation of all parts of the shelter with the exception of the bathrooms.  The ground floor also contains a food “servery,” a dry goods distribution center and adjacent to the MSNS, a small clinical area.  A loading dock, generators and other amenities, such as ice machines, warming ovens and industrial refrigerators and freezers are found on the ground floor as well. 

Although parts of the Megashelter (such as the registration area, dining area and parts of the CTNS) may be used for non-sheltering activities, the building was conceived as a fixed shelter and has served as such during Hurricanes Gustav, Ike, Isaac and Harvey.  At a cost of over 27 million dollars and an annual operational cost estimated at around $400,000, the Megashelter represents a major investment by the state of Louisiana in disaster preparedness.

When operational, the Louisiana Department of Children and Family Services (DCFS) serves as the shelter manager, while other ESF-8 functions are provided by the Office of Public Health (notably represented by the OPH Region VI or Central Louisiana), the Department of Wildlife and Fisheries, the Department of Agriculture, the Louisiana State Police and National Guard.  The Department of Transportation and other agencies of the Louisiana Department of Health (i.e. Behavioral Health, Medicaid, Office of Citizens with Development Disabilities and Office of Aging) all contribute to running the shelter.

Such a complex operation could be fraught with problems, but activities there have been achieved with minimal complications, notably with Hurricanes Isaac (2012) and Harvey (2017).  This paper focuses on the medical response (ESF-8) which may serve as a best practice for other entities responsible for handling large scale evacuations, with or without the luxury of a dedicated shelter.

On Wednesday, August 29, 2012, the rains associated with Hurricane Isaac resulted in extensive, unexpected flooding in St. John’s Parish, specifically affecting the city of LaPlace, Louisiana.  The resulting evacuations, orchestrated by the state of Louisiana emergency preparedness services, brought 1,597 evacuees to the Megashelter CTNS and another103 to the adjacent MSNS.  Many residents who would have qualified for the Medical Special Needs Shelter chose to stay with family members in the Critical Transportation Needs Shelter section.

Since the Office of Public Health, in association with other agencies of the Louisiana Department of Health, is responsible for the medical services (ESF-8), the organization of those services with limited personnel posed a particular challenge.  To satisfy the medical needs, OPH worked closely with available EMS contracted services.  A first aid station, operating 24 hours a day, was established in the CTNS section.  It provided basic services such as blood pressure and glucose checks, albuterol breathing treatments, over the counter medications and simple wound care.  During the seven days the Megashelter remained open, 685 patients were seen in the first aid station during the Hurricane Isaac event.........Continue

David J. Holcombe, M.D., M.S.A.