At 6:10 am, Monday, August 29, 2005, Hurricane Katrina made landfall in New Orleans as a category four storm with winds of 145 mph. At 9:00 am the Lower Ninth Ward levee was breached, with flood waters reaching six to eight feet in the immediate area. By 2:00 pm, the 17th Street levee failed, and flooding occurred in 20% of the city. On Tuesday, August 30, additional levee failures resulted in flooding in more than 80% of the city, with depths reaching 20 feet in some areas. The nation watched in disbelief as the city of New Orleans collapsed, and by 12:30 pm on Wednesday, August 31, refugees began to arrive at the Astrodome in Houston.1
The Tulane University School of Medicine (hereafter, Tulane) and teaching hospitals suffered extensive damage, and operations became unsustainable. By Wednesday, September 7, Tulane's leaders met with the leaders of Houston-area medical schools to develop and coordinate a plan for continuing Tulane's educational functions in temporary quarters provided in south Texas. For that purpose, the Alliance of South Texas Academic Health Centers was formed. The Alliance consisted of Baylor College of Medicine (BCM), Texas A&M University System Health Science Center College of Medicine, The University of Texas Medical Branch at Galveston, and The University of Texas Medical School at Houston. In the initial meeting, Tulane dean Dr. Ian Taylor described the intention to work with the Alliance in temporarily relocating Tulane faculty, staff, and learners to Houston to resume educational operations.2 Dr. Taylor proposed to have Tulane medical students in classrooms by September 26 and medical residents in training by October 1.
The details of the initiatives undertaken to ensure the continuity of quality educational experiences for Tulane learners are described in companion articles elsewhere in this issue of Academic Medicine. The tasks and ambitious timeline, however, were more daunting because of failures of communications across the region and the scattering of faculty, staff, students, and residents, who took different evacuation routes out of the flooded city. In this article, we detail experiences with information technology (IT) applications in addressing communication and coordination needs related to the initial recovery response. Implications for other academic health centers (AHCs) engaged in development and implementation of disaster recovery plans are also discussed.
These lessons may provide context to the concerns and efforts under way to examine disaster recovery and business continuity plans for IT at institutions of higher education in general across the country,3,4 and within AHCs in particular.5 In 2005, Info-Tech, a private-sector IT research and consulting organization, published a report indicating that 47% of colleges and universities had no IT disaster recovery plan. Furthermore, 32% of those organizations without an IT disaster recovery plan indicated that it might take up to three years before they had a plan in place.6 By 2006, disaster recovery and business continuity was fourth of the top 10 IT issues facing institutions of higher learning, having appeared only once previously, as 10th, in seven annual surveys since 2000.4 The importance of IT for early disaster mitigation and timely recovery is further underscored by a new report from the National Research Council (2007) that was in preparation as Hurricane Katrina struck New Orleans.7 It is our hope that sharing the experiences described below may provide insights regarding preparations that can be undertaken in advance to facilitate early phase recovery operations in the event of disaster.
Planning for Recovery
Relocating Tulane's medical school to Houston within three to four weeks required the development and implementation of a coordinated communication plan in the face of widespread communication disruptions caused by the hurricane. Contact information for faculty, staff, students, and residents was largely unavailable, and the e-mail system was inoperative. Land and wireless telephony was not functioning within the region, although some text messaging was possible. Relocation information or contact information for persons outside of the region who could serve as sources of contact for those displaced from Tulane was similarly unobtainable. The IT infrastructure was largely inaccessible; however, a single opening page for the Web site of the Tulane medical school could be hosted from the Tulane domain.
In collaboration with the educational leadership of Tulane, the early-recovery-phase communication requirements were defined. These included:
▪ Establishing communications with and providing guidance to faculty, students, residents, and staff regarding relocation to south Texas for purposes of continuing the educational experiences
▪ Facilitating person-to-person communications among members of the Tulane family and reestablishing communication between those at Tulane and the larger community of colleagues, relatives, friends, and others
▪ Obtaining contact information for Tulane faculty, staff, and learners
▪ Providing tools for Tulane administrators and staff to rapidly update and disseminate information electronically
▪ Identifying housing opportunities within Houston and the housing needs of Tulane students, faculty, and staff for purposes of matching individuals to available housing
▪ Developing content for and designing and deploying a Web site for meeting the above requirements as soon as possible
Tulane's Recovery Web Site
Between Wednesday, September 7, and Sunday, September 11, 2005, BCM faculty and staff worked with Tulane colleagues in developing the Tulane University School of Medicine Recovery Web Site-including its content, design, functions, and administrative tools-for approval by Tulane educational leadership. To expedite Web development, a content-management system previously developed by the Baylor Center for Collaborative and Interactive Technologies (CCIT) was redeployed for the Tulane site. (CCIT is a center within Baylor College of Medicine engaged in the research, development and application of innovative technologies in the creation of education, clinical decision support, quality improvement, and other resources for health care professionals, faculty, educators, students, patients, and families in the United States and around the world.) Cascading style sheets were used to define the presentation layer look and feel and navigational elements, and database tables were repurposed from earlier sites. Web site functions designed to facilitate providing living accommodations for those displaced from Tulane (e.g., submitting, requesting, and matching housing and supporting workflow and contact management) were developed de novo. Communication forums were implemented with modifications of preexisting open-source code.
On Sunday evening, September 11, at 7:09 pm, the Web site was launched via a notice on the temporary opening page on the Tulane medical school's Web site directing users to the recovery Web site. Twenty minutes later, the first message was received-an inquiry from a potential matriculant regarding application review. Within hours, thousands of user sessions were logged, with a peak of 78,000 pages of information delivered in one day. Within three weeks after students' and residents' relocations had begun, over 46,000 user sessions were recorded and over 540,000 pages of information were delivered.
Three Challenges
Challenge 1: To effectively communicate general and institutional information to Tulane's faculty, staff, and learners, and to provide mechanisms for rapidly updating and disseminating announcements and messages.
The response: This first challenge involved providing Tulane's leaders and administrators with the ability to quickly post information to a Web site that could be accessed by students, faculty, staff, and others who were scattered in locales across the nation. The solution involved development of a database-driven Web site. The database-driven approach was appealing for several reasons. Such Web sites dynamically build the Web pages requested by site visitors using information stored in and available from a database at the time of the request.8 A familiar example might be an airline reservation Web site, where the site is instantaneously and automatically updated when one makes selections from the list of available flights. Such sites are in contrast to static sites, where a programmer codes Web pages individually. A database-driven Web site was able, for example, to automatically and instantaneously display new messages or other contact information provided for public display by members of the Tulane community who were using the site to reconnect with their institution and colleagues during the relocation to Houston.
Additionally, such Web sites can be designed to include tools for use by individuals with limited or no experience in hypertext markup language (HTML) to permit rapid updating and dissemination of information. The Web site solution for Tulane was designed to enable authorized persons to create new Web-based content by adding or deleting entire pages; editing individual page elements or modifying text elements to headlines, body copy, or lists without the burden of entering HTML tags; and directing content for posting to specific sections within the Web site. With the recovery Web site, Tulane staff members were also able to modify navigation, create new sections within the site, and repurpose content for different audiences throughout the site. Thus, announcements or other information could be uploaded one time and directed to display within the content areas of multiple audiences-faculty, students, residents, and/or staff, as appropriate. Because it was recognized that reaching the dispersed Tulane community might not occur simultaneously and that initial announcements could be missed by those arriving late, the site was developed to enable administrators to list important earlier postings in a navigation column on the right for rapid review. During the weeks immediately after the launch of the recovery Web site, technical staff at CCIT/BCM provided assistance with site posting; however, as Tulane personnel became available, site updating and management was transferred to Tulane staff, increasing their autonomy and reducing the burden of support required from site developers.
Challenge 2: To gather location, contact information, and status of the various members of the Tulane medical school community; provide a means for sharing that information with the larger community, including families, friends, and coworkers; and facilitate person-to-person communications across and within the various populations.
The response: In addition to a section entitled The School, other sections (entitled Students, Residents & Fellows, Faculty, and Staff) were created for posting information specifically targeting these audiences. Within the sections were links entitled Tell Us Where You Are. When a visitor clicked on such a link, he or she was taken to a page that provided a form requesting details, including name, current location (address, city, state, phone number[s], and e-mail address), alternate contact information for someone not displaced by the hurricane who could reach the displaced individual (e.g., family member or friend), audience-specific information (e.g., for residents, the department and year of residency), comments that could be posted on the public site (e.g., the individual is safe and can be reached at a particular cell phone number; offers of travel assistance to Houston), and preference regarding inclusion in the public list of located individuals. The lists of located members of the Tulane community were used widely by that community, as well as by family, friends, colleagues, and patients. After the launch of the site, 1,588 registrations were received: 884 students and residents and 704 faculty and staff.
Online forums providing the capability for users to post messages and follow threaded discussions were established to facilitate asynchronous communication that had been severely limited with the disruption of e-mail and other communication channels. The forums were active and received over 750 postings, augmented by over 100 e-mails received via the Web site. Topics of messages submitted to the forums were categorized by the message authors into the following groups (with percentage of total postings in parentheses): students (29%), faculty (24%), Tulane Web site questions (18%), general announcements (18%), staff (5%), residents and fellows (5%), and housing (1%). Issues included locating faculty and staff; administrative and business operations, including financial aid and student loans; the status of medical school applications; confirmation of education for credentialing; offers of assistance to faculty and staff; inquiries from patients regarding medical care and locating health care providers; social support; instructions for evacuation from Houston when Hurricane Rita threatened the Texas Gulf Coast within a month of Katrina; and employment offerings for displaced faculty, among other items. Presumably because of the nature of the disaster, several individuals inquired about the status and safety of family members who had donated their bodies to the school for scientific and/or educational purposes.
Challenge 3: To acquire, classify, coordinate, and manage housing providers/donors in the Houston area, and to connect those resources to those in need in the Tulane community.
The response: In light of the aggressive timeline for relocation of Tulane faculty, staff, and learners to the Houston area, housing opportunities-including donations and rentals-needed to be rapidly identified and matched to the needs of faculty, staff, and learners arriving in Houston. Tulane students, residents, fellows, faculty, and staff were invited to submit housing requests online if they chose. This information included demographics, contact information, and other details (e.g., the number of adults and children, pets, rental or donation preference, monthly rental range [if applicable], housing type preference, number of required bedrooms and bathrooms, furniture requirements, roommate preference, and preference to work with a realtor). Houston-area residents and businesses wishing to offer housing, either as a donation or for rent, were able to complete a similar form. Tulane students and personnel could also review currently available housing online and request particular accommodations in priority order.
The creation of this resource enhanced the ability of the Alliance of South Texas AHCs to support the rapid relocation of Tulane personnel into the Houston region, and it also effectively engaged many members of the public in efforts to contribute and/or provide assistance to those displaced by Katrina. For reasons of safety and confidentiality, each housing offer and request was individually reviewed and matched.
The custom-created Web-based tools enabled staff in Baylor's Office of Public Affairs to coordinate housing requests with housing offerings as they became available. Web site features permitted staff to manage the complete process, including receiving requests regarding housing requirements, reviewing rankings of posted accommodations for purposes of matching against available inventory, managing inventory, and controlling the communication process such that multiple staff members could handle exchanges between housing requestors and providers without duplicating their efforts. Within a little over two weeks, between September 15, 2005, and September 31, 2005, over 200 displaced students, faculty, and staff were successfully matched with housing options using this service.
Completion of the Early Recovery Effort
The Tulane recovery Web site continued operations for a six-month period; however, with completion of relocation efforts in early October and reestablishment of communication channels in the Houston area (e.g., e-mail, telephone), recovery Web site use decreased. Announcements continued to be posted on the Web site by Tulane leadership into December 2005. By early in the first quarter of 2006, recovery of Tulane's IT capabilities was well under way, and the recovery Web site was no longer needed. It was formally decommissioned in early March 2006, having delivered approximately 890,000 pages of information in over 100,000 visitor sessions.
Implications for Responses to Future Disasters
The BCM experience in collaborating with other institutional partners in the region to respond to the challenges posed by Katrina provides evidence for the value that such efforts can offer in rendering assistance to people confronted with catastrophic events. These collaborative efforts involved creation of temporary enabling infrastructures that allowed the resumption of at least some of the essential communication and other functions needed by the academic community of Tulane's medical school. Although the efforts we have described in this article were limited in focus and scope, the tools for locating faculty, staff, and learners; reestablishing communications; and facilitating relocation efforts for an AHC contributed in meaningful ways to the much larger efforts to address the needs of the shattered community.
The Katrina experience also offers evidence of the need for the academic community in general and AHCs in particular to engage in more structured and systematic planning efforts, including preparedness, mitigation, response, and recovery as outlined in the Brief Guide for Academic Health Center Disaster Preparedness and Response,5 distributed by the Association of Academic Health Centers in 2006, and in the recent report from the National Research Council.7
Katrina-related events do not represent the first time that AHCs have played an important role in responding to community-specific threat. In 2003, as a SARS outbreak took shape in Toronto, Canada, the continuing medical education office at the University of Toronto mounted a focused effort to inform area clinicians about the threat and to help them provide effective services to individuals and to the larger community.9
The experience related to Katrina has brought into sharp focus the essential role that effective use of information technologies can and will play in managing threats to communities from natural occurrences or human actions, intentional or unintentional. The expertise and technology-rich environments of AHCs provide both the opportunity and the obligation for such centers to provide critical leadership in preparedness planning for threats to our communities and regions. Drawing on AHC resources to create, share, and deploy, in a proactive fashion, critical disaster-response mechanisms can play a vital role in ameliorating the effects of catastrophic events on our communities, patients, students, faculty, and staff.
Acknowledgments
The authors are very grateful for the opportunity to work with Drs. Ian L. Taylor, N. Kevin Krane, Marc J. Kahn, Ronald G. Amedee, Paul K. Whelton, and the Tulane students, residents, fellows, staff, patients, friends, families, and colleagues, whose courage and optimism throughout the ongoing recovery from Katrina continues to provide a model for all.
References