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On this second anniversary of the disaster now known by a single word - "Katrina"

all of us in disaster response look around and shake our heads. One year ago we saw misstep after misstep, failure after failure. As we look back over a landscape that is still scarred by the aftermath of flooding and looting to see both despair and rebirth we ask ourselves: Are we any better prepared today?

Two recent reports by the national Academies of Science clearly stated that Americas hospitals and emergency rooms are no more prepared now than one or even five years ago. Worse, hospitals have failed to integrate emergency medical services (EMS) into their planning and response operations. This first link in the chain is not broken it is simply unhitched.

What happens the next time Mother Nature roars? We cannot yet mitigate an earthquake or a hurricane, a tornado or a volcano. We have yet to learn how to immunize our planet against the next great pandemic or the next plague.

Why is it after we see one of the great cities of america laid low and sunk beneath the waters of its own shores that we have yet to do any meaningful planning? This is not our governments fault. Money is available and spent every day for training. Why we must fight to get any hospital to train to avoid the next catastrophic failure in the wake of unavoidable disaster?

On those occasions when healthcare does choose to train, it is discouraging to see a room more than half empty. In a profession that loudly proclaims a dedication to patient safety and customer care, to see so few people interested in preserving the most necessary of community resources, healthcare, is demoralizing beyond words. disasters can seldom be avoided. On the other hand, catastrophe can almost always be averted with conscientious planning and practice. The difference between a disaster and a catastrophe is that while disaster is when needs exceed resources, catastrophe is when needs exceed all ability to respond.

Equally disturbing is the territorialism among the specialties, each one laying claim to disaster medicine. Most healthcare delivered after a disaster is a simple the daily practice medicine under the worst conditions. These groups fail to realize that Disaster Medicine is primarily practiced before the disaster ever strikes. Disaster Medicine Specialists are part and parcel of planning for the community disaster response and the elimination of profession-specific silos of authority and knowledge. Rather than embracing the concept of board certification in the new specialty of Disaster Medicine, these territorial and fractious groups seek to stake their claim. They have learned nothing.

The good news, Disaster Life Support (DLS) has become the national standard for preparedness of individuals, families, businesses and healthcare professionals, Healthcare first Responder training (HFR) has become the ruler by which hospitals and other healthcare institutions are measured. While it is frustratingly difficult to get these audiences to come to class, it is immensely rewarding when they finally understand how important it is to be prepared, to be aware and to be able to protect themselves, their families, their communities, and their patients. Much like the early days of CPR, it will take time for the nation to understand the importance of every man, woman and child knowing what to do when the wind blows, the buildings falls, or the whole planet sneezes at once. Until then, we who teach these most precious skills will continue to strive to ensure that everyone goes home alive at the end of the day.

Will the gulf coast and New orleans recover?

Certainly in time.

The bigger question is will we ever learn to be D.I.S.A.S.T.E.R. R.E.A.D.Y. & P.L.A.N.?

Dr. Maurice A. Ramirez is the founder and president of the consulting firm High alert, LLC.. He serves on expert panels for pandemic preparedness and healthcare surge planning with Congressional and Cabinet Members. board certified in multiple specialties, Dr. Ramirez is Founding Chairperson of the American board of Disaster Medicine and serves the nation as a Senior Physician-Federal Medical Officer in the national Disaster Medical system. Dr. Ramirez has a new book: You Can Survive Anything, Anywhere, Every Time. His website is http://www.High-Alert.com

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