Even though many situations are significantly improved in the first 72 hours, some are not.
Masters: A source of non-grid power. I have solar panels on my roof with a battery-backup. Also have a way to purify water. A micro-pore filter sold by camping stores is a good solution. Faidley: That depends on what kind of money you have. The first thing is some type of lighting system or flashlight you can use for a week or longer, along with the batteries to run it. There are also solar-powered lanterns you can charge during the day or crank-power, which is even better, because you don't have to leave it out in the elements. Those are good ideas for a secondary source. They used to say to keep three days of food, but you should have at least a week—and if you can afford it, two weeks—of non-perishable food.
And water is a big thing. If you can't buy bottled water, fill up everything in your house. Fill up the bathtub. Fill up the sink. Save old water cartons to fill. This communication tool and any other type of portable radio can provide survivors with lifesaving information, such as emergency broadcasts, evacuation orders, shelter-in-place instructions and much more.
While any radio is better than none, a weather radio is the best choice, as it can tune in your local weather radio bands—which are one of your most reliable sources of emergency information. Masters: Cell phones are great, but the towers can go down, so a land line is handy. Another critical thing to have in your survival kit is a battery-powered radio that can receive NOAA Weather Radio broadcasts.
Get one that has the feature to alert you when a weather warning is issued for your county. Information is critical in today's world, and stations will give out information to people: where to get food, where to go for medical assistance, what hospitals are open. MacWelch: Staying calm is the most important thing a person can do during any emergency. Of course, this is easier said than done in a scary situation, but think of it like this. A little fear is a natural and healthy response to a frightening event.
But when fear runs unchecked this state is commonly known as panic , a person may make irrational, dangerous, or even deadly choices. Staying calm and preventing panic should be a priority for each person during a crisis. MacWelch: A lot of people forget to focus on their most basic needs, also known as survival priorities. Shelter, water, air, food, security, sleep, medical care, and some semblance of hygiene will keep a person alive for a very long time.
But quite often, these basic needs are confused with wants. People want to save possessions and they want to have their normal comforts and entertainment. Faidley: The thing people probably forget most often is that a natural disaster can be a very long-term event. You have to remember, during a hurricane, there's not much you can do about it then.
You need to hunker down and be safe, but you have to remember it can be a long time for recovery. Either evacuate or have enough survival supplies for a week or longer. What dangerous scenarios could arise during these situations that people might not consider? MacWelch: I mentioned hygiene as one of the basic needs for a person, and it really is a need—not just a nicety.
Something as simple as the lack of a handwashing station at the bathroom can allow hazardous pathogens to spread through a group in hours. Faidley: Believe it or not, in most urban areas, the period after a hurricane is usually the most dangerous. You have fallen trees and some trees that have only partially fallen. You have power lines. You have sharp objects. You have gas leaks. You have broken glass and windows. You may have a boil-water order in your area. During Hurricane Harvey, it was the flooding.
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And one of the most dangerous things after a disaster are uncontrolled intersections. People go down the road, and they'll drive right into a major intersection without even stopping. People are upset and not paying attention, and that is really dangerous. It can also be dangerous for children to play in the water, since there could be open manhole covers sucking the water down.
Faidley: If you're in the middle of a hurricane, you want to be in the most stable part of a building. You want to stay away from the windows and be in the most interior portion. You want to put as much room between you and any flying or falling debris. A animal rescue volunteer carries a small dog he found abandoned inside a flooded home after Hurricane Harvey. If a natural disaster forces an evacuation, it's best to evacuate with your pets or take them to a shelter. Faidley: I have a big problem when people tie their pets inside or outside their house.
They have a wonderful ability to swim and climb trees. The odds of a free animal sheltering themselves is much better than one that is chained. Faidley: Mainly you shouldn't be in that water. It's something you can usually prevent. Stay out of the water as much as possible. MacWelch: This situation is quite common. Once the power fails, the water fails soon after. For those who have never sourced their own water before, the task seems scary and mistakes are almost inevitable. But thankfully, there are many ways to gather water and multiple ways to disinfect it.
One of the easiest plans is to find the clearest water you can and boil it for 10 minutes to kill any pathogens. Masters: Keep yourself from sweating by sheltering from the sun and reducing activity. Find groundwater sources near or underneath green vegetation, canyons, dry riverbeds or rocks. Cover as much skin as possible with loose, lightweight clothing. This will trap the sweat against your skin, slowing evaporation and therefore water loss.
For this reason, it's probably best to go with a cotton undershirt rather than a wicking fabric. Cover it all with a light windbreaker. Wear a wide-brimmed hat, sunglasses, and gloves. Faidley: It will be pretty unusual to not have some type of water. Right after the storm, there's a lot of rainwater around, but you have to use common sense. You can't drink something that's contaminated, though you can buy water purification tablets, use chlorine, or boil water if you have power or gas.
Plan ahead. MacWelch: Well, let me answer your question with a question. Is it ever safe to die of dehydration? Floodwaters are notorious for being a bouillabaisse of muddy water, raw sewage, dead animals, and toxic chemicals. That being said, it may also be the only water you have.
Ironically, stranded flood survivors have found themselves praying for more rain—which is a clean and useable source of water. There's usually gallons of clean water in there. If you're the MacGuyver type and you know how to improvise any of the different apparatus for distillation, then distill the raw floodwater. Or failing that—boil the water for 10 minutes and drink only enough to maintain a low level of hydration. This limits your exposure to chemical pollution in the floodwaters.
MacWelch: Regardless of the type of calamity, look for canned food in the wake of a disaster. The label may have fallen away, in which case the can contents will be a surprise, but mystery food is better than no food. Canned goods are surprisingly tough, waterproof, impervious to insects and most animals, and edible whether served hot or cold. Volunteer rescue workers in Mexico City have their names, blood type, and telephone numbers written on their arms in case they're caught in an emergency situation and cannot provide the information verbally. Myth 8: Food aid is always required for the victims of natural disasters.
Fact: Massive food aid is not usually required; natural disasters only rarely cause loss of crops. Myth 9: Clothing is always needed by disaster victims. Fact: Clothing is almost never needed; it is usually culturally inappropriate, and although it is accepted by disaster victims it is almost never worn.
Myth Things return to normal within a few weeks. Fact: Disasters have enduring effects and major economic consequences. International interest tends to wane just as needs and shortages become more pressing. The present review supports the generalizations overall, but sets the behavioral observations in a context of the social attachment model of psychosocial needs and behaviors.
As noted by de Goyet, 1 immediate lifesaving needs are almost always met by the local population rather than by outside medical volunteers. Only medical personnel with skills that are unavailable in the affected area may be needed. The U. However, short-term health and medical needs were largely met following the hurricane. In fact, in locations where overall coordination and infrastructure were lacking, attempts to provide direct care distracted attention from more urgent tasks of meeting security and other immediate needs. Many clinicians and health-care organizations self-deployed to Louisiana following Hurricane Katrina, but their arrival occasionally compounded the disorganization of health services.
Physicians wrote prescriptions for hypertension and diabetes, but there were no pharmacies open or even available to fill them. Lacking an assigned role, and in the absence of communication facilities and electrical power, many volunteers were unable to meet the actual needs of victims. Emergency workers from Canada, however, were the first to arrive at the Hurricane operations center in St.
Bernard Parish, a New Orleans suburb of 70, people, on August 31, The team of 45 was warmly welcomed by the parish president, rescued people from flooded homes, treated about patients, saved many evacuees, and resupplied a local medical clinic before returning to Canada on September 6, But those with poor resources would clearly benefit from intervention by structured disaster response teams. Because Hurricane Katrina destroyed businesses as well as the medical and public health infrastructure along a broad swath of the U. Gulf Coast, including New Orleans, assistance from federal agencies was essential.
CDC, for instance, deployed approximately professionals for recovery operations. However, the severity of wind damage and flooding was shown by a survey of evacuees in Houston. Of those trapped in their own homes, half of them waited three or more days to be rescued. Within 14 days after the hurricane, ARC and the Mississippi Department of Health had established case definitions of illnesses and set up a toll-free number for shelter staff to report illnesses.
The medical team deployed from ARC headquarters in Washington, DC, performed critical-needs assessments and helped define the public health response to the hurricane. Within four days, multidisciplinary and interagency ARC teams had assessed more than shelters housing nearly 30, people and provided care to about 50, displaced people. These teams rapidly identified immediate and longer-term needs and developed a coordinated response plan.
President George W. Bush did not request foreign aid officially, but offers of aid from the United Nations and approximately 90 member countries were received by the U. In New Orleans, health services were provided by Ochsner Clinic, located at the more elevated, southwestern end of the city, as well as by other local medical institutions including Touro Infirmary in the uptown area and East Jefferson General Hospital in the suburb of Metairie that had escaped major flooding. For example, more than 9, hospital beds in New Orleans were unusable because of flooding; 8 shelters had difficulty obtaining medications; 16 and many health-care workers were themselves displaced by the hurricane.
Makeshift clinics in the larger shelters had limited supplies but provided medical support. Patients were seen effectively in clinics, and hospitals were open with sufficient bed capacity in at least six different communities of the Gulfport region, not necessitating assistance from the NIH medical mission team. These observations on Hurricane Katrina, though far from representative, support de Goyet's thesis that disaster-related needs are met by national and local governmental agencies.
However, were it not for the massive resources available for mobilization within the U. Intuitively, epidemic diseases, illnesses, and injuries might be expected following major disasters. However, as noted by de Goyet, epidemics seldom occur after disasters, and unless deaths are caused by one of a small number of infectious diseases such as smallpox, typhus, or plague, exposure to dead bodies does not cause disease.
The keys to disease prevention are excellent sanitary conditions, swift and competent response management, and public education. Cholera and typhoid seldom pose a major health threat after disasters unless they are already endemic. Louis encephalitis, and dengue have ties to the Mississippi delta, 23 and vast areas of stagnant and tainted floodwaters following Hurricane Katrina caused concern about vector-borne diseases. But there were no reported outbreaks of these illnesses in Mississippi. Extensive damage to the infrastructure of the Louisiana Department of Health and Hospitals LDHH resulted in limited opportunities for disease surveillance, although resources in Louisiana were rapidly mobilized to restore essential public health services.
CDC, the LDHH, functioning hospitals, disaster medical assistance teams, and military aid stations established an active surveillance system, beginning September 9, , to report post-hurricane injuries and illnesses, initiate interventions, and deliver prevention messages to residents and relief workers. It is commonly assumed that the social contract is tenuous at best and that major natural disasters and other crises trigger mass disruption, disorder, and social breakdown.
While there were well-documented instances of brutal hijacking, rioting, and looting in New Orleans after the deep flooding caused by the hurricane, there were many more reports of altruism, cooperativeness, and camaraderie among the affected population. Following Hurricane Katrina, many residents of Baton Rouge, for example, invited someone to stay in their home; hotels housed displaced families, extended families, and pets; and nearly every large shelter created a clinic run by local doctors and nurses. Notwithstanding the chaos and confusion, the medical staff remained calm and communicated coherently, dispensing care and comfort.
A flashlight-illuminated talent show was held in which everyone was invited to participate, including patients with masks donned to prevent the spread of tuberculosis. Against the common misconception that disaster victims are too shocked and helpless to take responsibility for their own welfare and survival, many find new strength and resiliency during emergencies. Thousands of local volunteers spontaneously united to sift through the rubble in search of victims after the Mexico City earthquake.
Similarly, following Hurricane Katrina, despite the loss of infrastructure and power outages at some shelters, the affected population engaged in active coping behavior. A common misconception is that disasters tend to strike human populations at random. On the contrary, de Goyet notes that disasters typically strike more vulnerable groups the hardest, such as those on low or fixed incomes, and especially women, children, elderly, and disabled people who tend to reside in more exposed locations and have fewer resources.
Hurricane Katrina was a special case because of its enormity and severity, and its impact was felt by entire communities across the Gulf states of Louisiana, Mississippi, and Alabama. Others sought refuge in hospitals, nursing homes, upstairs in their own homes, or on elevated highways. In a survey conducted in Houston shelters soon after the hurricane September 10—12, , more than a third of respondents reported that lack of a car or other means of transportation was their main reason for not evacuating.
It has been said that locating disaster victims in temporary settlements is the best solution to the housing problem. To the contrary, this is the least desirable option according to de Goyet, who suggested that construction materials be purchased and homes rebuilt in the affected areas. In the case of Hurricane Katrina, however, the widespread destruction of residential neighborhoods and of shopping areas and infrastructure made immediate reconstruction impracticable, and temporary housing had to be found for the estimated , homeless evacuees from New Orleans and the coastal regions of Mississippi and Alabama.
Tendencies to remain in disaster areas and to refuse or delay evacuation have been noted in other disasters. By February 18, , FEMA had provided 42, travel trailers and mobile homes to residents in Louisiana alone, 40 in part to encourage workers to return to their jobs and save businesses that would otherwise fail.
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Intimate partner violence rates also rose threefold above U. It is commonly thought that food aid is always required following natural disasters. However, crop failure is not the only situation in which food aid may be needed on a large scale in a disaster. In regard to Hurricane Katrina, many who failed to evacuate prior to the hurricane endured several days without food, if not water.
Even in relatively unaffected areas shops and stores were closed; hence, large numbers of people had to rely on outside assistance. Distressing images were shown on television of stranded victims lacking basic necessities and exposed to human waste, toxins, and physical violence. Most shelters on the Mississippi coast received adequate supplies of food and water, but there were concerns about the safety of drinking and showering water, wastewater disposal, and reliance on portable toilets for water in some shelters. The magnitude and urgency of the need for food and potable water after the hurricane were unprecedented.
The manual of the U. ARC recommends a gallon 4. Although needs may be greater in hot weather, the amount needed for 20, people the number housed in the New Orleans Convention Center , based on a liter requirement, translates into , liters, or about 79, gallons of water per day. These facts point to the importance of ensuring that required amounts of food, water especially potable , and other essential supplies are deliverable at large and secure venues designated as staging areas, to prevent a man-made disaster from following a natural one.
By September 17, , in Orleans Parish alone, winds and flooding had resulted in structural damage to approximately 3, wholesale and retail food establishments. Loss of power and floodwater in affected areas also resulted in food spoilage and contamination. The main water treatment facility on Carrollton Avenue had low water pressure throughout the distribution system. The USDA delivered food and nutrition assistance to states directly affected by Hurricane Katrina as well as host states. For more than three weeks, massive food aid was provided for nearly , households by FEMA.
Pre-disaster emergency planning should include assigning responsibility to local people for maintaining critical infrastructure. For example, during Hurricane Floyd—which struck North Carolina on September 16, —engineers made it possible for the Pitt County Memorial Hospital to use the Rehab Unit swimming pool as a watertight reservoir to pressurize the water system for providing potable water and flushable toilets throughout the hospital. Clothes are one of the major items donated after disasters, and clothing, along with other basic necessities, is routinely provided to disaster victims by emergency relief organizations.
In the case of Hurricane Katrina, the rapid and devastating flooding of New Orleans created by breaks in three levee systems led to massive losses of homes, possessions, and employment. As a result, clothing, bedding, and footwear were needed on an unprecedented scale, not only in early phases of the disaster but also as temperatures cooled and fall turned into winter. Relief agencies and many neighborhood and charity organizations collected donated clothing for evacuees, and school systems provided uniforms for children Personal communication, Karen Quay, Director of Evacuee Resettlement, Lutheran Episcopal Services, Jackson, Mississippi, May Contrary to popular misconception, disasters can have profoundly adverse effects and major economic consequences that can take months or years to overcome.
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A return to normalcy seldom occurs quickly. Developing countries and even relatively impoverished and economically precarious areas in generally prosperous countries can deplete most of their financial and material resources in the immediate post-impact phase of major natural disasters, so relief programs have their greatest impact when international interest declines and local needs and shortages become acute. In the year history of New Orleans, the city has had 27 major river- or hurricane-induced disasters at a rate of one about every 11 years.
Figure 1 shows a plot of the reconstruction experience for one year after Hurricane Katrina and projects future reconstruction activity by using the four periods of historical experience. The sequence and timing of reconstruction after Hurricane Katrina in New Orleans a. The long-term projections dashed lines are based on an emergency period of six weeks, a restoration period of 45 weeks, and an expected tenfold increase in the duration of reconstruction compared with previous disaster experience.
Reconstruction of New Orleans after Hurricane Katrina: a research perspective. The adverse effects of Hurricane Katrina on the physical environment as well as business and residential infrastructure continue to be felt, and the consequences for both physical and mental health are still being documented. In some areas, relief agencies are still struggling to build sustainable procurement and distribution systems to address long-term needs. A major health issue for displaced populations has been the reduced ability to manage preexisting or worsening chronic illness, including mental illness, which can be compounded by diminished community resources.
A study of 18, evacuees relocated to San Antonio after Hurricane Katrina reported a substantial demand for drugs used to treat chronic conditions. Health-care encounters from September 2—21, , were monitored using a patient syndromic surveillance system based on major complaints that were classified as either acute or chronic, and medication-dispensing records were collected from federal disaster relief agencies and local pharmacies. Chronic illness in disaster survivors can also be exacerbated by adverse weather conditions, lack of food or water, and physical or emotional trauma.
Those with mental illness or disabilities, low incomes, and lack of regular access to health care are most at risk. For many Katrina survivors, uncertainty and disrupted health services had enduring effects that were compounded by environmental contamination due to toxic floodwater, as well as localized threats such as fire ants, rats, and water moccasins. Initial tests by the EPA and the Louisiana Department of Environmental Quality ruled out high fecal bacteria counts and exposure to chemicals as potential causes of serious health effects.
Long-term support and follow-up will be needed for those psychologically traumatized by the storm and related stresses, ranging from separation from family members, pets, and possessions to perceptions justified or imagined of hostility or indifference on the part of officialdom or strangers in other areas to which people were summarily evacuated. In the continuing aftermath of the disaster, competing proposals for rebuilding the health-care infrastructure, often backed by conflicting interest groups, resulted in cumbersome decision-making and slow implementation.
New Orleans had 3. By May , there were only 1. Total hospital capacity was also reduced and fewer health-care providers were available. The Medical Center of New Orleans formerly Charity Hospital remains closed, forcing indigent patients to travel 75 miles to the nearest safety-net hospital in Baton Rouge; and there was confusion about which hospitals were open and what services were provided. Reprinted with permission from Louisiana Hospital Association. Utilization trends, March 17, [cited Mar 18]. The restoration of this vital center of commerce, intermodal transportation, and culture is slowly proceeding, but questions remain about how to rebuild damaged areas of the city and its levees and wetlands, and the extent to which further catastrophic flooding can be prevented or managed.
This review of the public health impact of Hurricane Katrina tends to support de Goyet's generalizations about disasters, 1 except for Myths 8 and 9, regarding the need for food aid and clothing, respectively. In fact, food aid was provided by FEMA to about , households for more than three weeks. Clothing was also needed on a massive scale due to the loss of, or evacuees' protracted separation from homes, possessions, and employment related to the hurricane. Indeed, the destructive power and extent of the damage caused by Hurricane Katrina was unprecedented in the U.
Regarding the issue of psychosocial responses to disaster, it was believed and hyped in the media that massive trauma led to the abandonment of social mores and relationships and even to violence, as people attempted to escape or to satisfy their own individual needs Myth 4. To the contrary, studies of behavior in disaster show that the great majority of those directly affected tend to remain calm and behave in an orderly and considerate fashion.
Although de Goyet presented his generalizations without an overall conceptual framework, his observations related to psychosocial needs and behaviors can be usefully framed in the context of the Social Attachment Model of collective responses to threat and disaster. Hence, the overriding tendency expected in disasters would be to seek the familiar and, in particular, the proximity of attachment objects rather than flight or passivity. Thus, increases in altruism, camaraderie, and social solidarity would tend to occur at the community level rather than social breakdown and individualism.
Being in proximity to attachment figures also influences the perception of danger and reduces fear, so that in situations where individuals are physically close to their attachment figures and objects, as in community disasters, even severe environmental threats normally induce affiliation rather than flight. Indeed, separation from loved ones and familiars is generally a greater stressor than physical danger itself. Against the view that disasters cause overwhelming self-interest and social breakdown, manifested in aggression, looting, or rioting Myth 4 , a large body of evidence indicates that the dominant response in community disasters is indeed to seek telephone and physical contact with loved ones and possessions as well as other familiar people and places affiliative behavior.
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Contrary to the view that affected populations respond with shock, helplessness, and overall passivity Myth 5 , the tendency toward social affiliation also leads to a multicultural dedication to the common good, expressed in altruism, camaraderie, and social solidarity among victims, enabling many to find new strength and resiliency during the emergency and to respond positively and generously. The greater the danger sensed by people in their familiar environment, the more likely they are to strengthen their attachments with family, friends, and neighbors, and to develop new attachments with people sharing the same environment, overriding traditional differences and barriers among people such as race, age, and socioeconomic status.
The Social Identity Model of crowd behavior 57 also postulates that altruism and self-sacrifice occur when a common identity emerges among people in the same predicament, even when great risk is involved. These tendencies were all in evidence during Hurricane Katrina and its aftermath, yet sporadic rioting and acts of violence also erupted after the hurricane at the New Orleans Superdome and other areas in the city business district. Human beings under threat of death are not invariably motivated by a simple drive for physical safety. As noted, rather than fight or flight, the typical response to danger is to seek the proximity of familiar people and places, even if this involves remaining in or approaching danger.
Official organizations often have difficulty in getting people to evacuate before disasters, partly because family ties and other attachments home, possessions, and their safeguarding keep individual members in the danger zone. While residents tend to remain in the disaster area, those who flee often lack attachments to the area.
However, when residents are forced to evacuate, they strive strongly to do so as a group or in family units, thereby maintaining contact and proximity with familiars. Evacuees also tend to orient themselves in the direction of relatives whose homes are outside the danger area, while those forced to go to official evacuation sites form clusters that partially duplicate their old neighborhoods.
Affiliative behavior and interactions with family or community members often continue at a high level of intensity and frequency for years after disasters. Physical danger as a whole is generally far less disturbing or stressful than separation from familiar people and surroundings. During the London bombing raids in World War II, children showed few signs of distress, even if exposed to scenes of death and violence, if they were with a parent or with schoolmates and teachers; it was only if they were separated from parents or other attachment figures under these conditions that serious psychological disturbances occurred.
Indeed, the literature on disaster suggests that the greater the loss of the familiar social and physical environment, the greater is the adverse impact on mental health and social adjustment. Following Hurricane Katrina, only about 50, people went to shelters. Consistent with the social attachment model, 7 most of the nearly one million displaced people went to the homes of family and friends or stayed together in hotels.
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Evacuees who had to rely on emergency transport out of the city were taken to totally unfamiliar locations, and some family members were taken to different locations. A tracking program was launched by the Centers for Medicare and Medicaid Services to remedy this situation. However, these venues were suitable only for the briefest occupancy. There is a major practical implication of the social attachment model regarding official policy for disaster preparedness and response: that is, a high priority should be given to keeping family members and pets united and even entire neighborhoods where possible during evacuation and resettlement, so as to preserve social attachments and thereby minimize the adverse effects of separation on mental and physical health.
To that end, training programs could usefully be developed for first responders and volunteer aid organizations. Such programs would provide information on the importance of social attachments in understanding how people respond to community disasters, and would offer strategies and guidelines for respecting and helping to maintain social attachments in the affected population in the event of major disasters.
In fact, many states have developed State Animal Response Teams to deal with issues of providing temporary housing for pets with or near their owners, recognizing the vital importance of pets to their owners, and the fact that many owners will refuse to evacuate without them. National Center for Biotechnology Information , U. Journal List Public Health Rep v. Public Health Rep. Anthony R. John C. Author information Copyright and License information Disclaimer.
Address correspondence to: Anthony R. This article has been cited by other articles in PMC. SYNOPSIS Misconceptions about disasters and their social and health consequences remain prevalent despite considerable research evidence to the contrary. Myth 2: Is international assistance needed? Myth 3: Do epidemics and plagues follow disasters?
Myth 4: Do disasters trigger social breakdown? Myth 5: Are those affected unable to take responsibility for their own survival? Myth 6: Do disasters kill at random? Myth 7: Should disaster victims be housed in temporary settlements? Myth 8: Is there a need for food aid? Myth 9: Is clothing needed by disaster victims? Myth Does life return to normal in a few weeks? Open in a separate window. Figure 1. The sequence and timing of reconstruction after Hurricane Katrina in New Orleans a a Actual experience solid line and sample indicators for the first year are shown along a logarithmic timeline of weeks after the disaster.
Figure 2. General acute patient days December as a percentage of Reprinted with permission from Louisiana Hospital Association. Geneva: World Health Organization;