The article linked below is pretty horrific, and describes what is known about the choices that were made at a hospital in New Orleans after Katrina, including the decision to euthanize patients. There’s a lot to think about in the article, but for people involved in disater relief, emergency management, or other aspects of disaster planning, It’s important to note how the situation begins.

Of course, it begins with a hurricane. and with failing levees, but from the point of view of the people at the hospital, and the ones who were ultimately put in the position of making these decisions, it begins like this:

“Susan Mulderick, a tall, no-nonsense 54-year-old nursing director, was the rotating ‘‘emergency-incident commander’’ designated for Katrina and was in charge — in consultation with the hospital’s top executives — of directing hospital operations during the crisis. The longtime chairwoman of the hospital’s emergency-preparedness committee, Mulderick had helped draft Memorial’s emergency plan. But the 246-page document offered no guidance for dealing with a complete power failure or for how to evacuate the hospital if the streets were flooded.”

It is impossible to plan for everything that might happen. Many things that could happen are of such low probability that there are not planning contingencies made for them. But even of these “rare” events, there are some which will lead to catastrophe and those deserve extra attention. NASA knows this, and some failures are classified as causing “loss of life” – these get extra attention.  Hindsight is perfect, but it seems that generator failure and managing evacuations are two things that are obvious candidates for consideration in a disater plan. In this case we have a series of events with various (arguably) low probabilities – Hurricane strike -> Levee Failure -> Hospital flooding -> Generator failure -> Evacuations, which led to life and death decisions being made under horrific conditions by people who had no advance plan or guidance for those types of decisions.

Plan, drill, revise the plan. Repeat.

Here’s the story: The Deadly Choices at Memorial.