Stress and Cardiovascular Disease: Lessons From Katrina

Edward D. Frohlich, M.D., F.A.C.C.; Robert S. Schwartz, M.D., F.A.C.C.



In This Article


Dr. Schwartz: I'm Rob Schwartz from the Minneapolis Heart Institute and this is a special ACCEL interview. I am with Ed Frohlich, who is the Alton Oschner Distinguished Scientist at the Oschner Medical Foundation here in New Orleans. Ed is going to talk about his experiences through the Katrina disaster. Welcome, Ed.

Dr. Frohlich: Thank you very much. To begin, I must say how grateful the people are in New Orleans that the American College of Cardiology could bring their meeting here at a time when no one could be certain how successful a meeting might be. We welcome all the people who came here and appreciate the support from the ACC.

Dr. Schwartz: From a personal standpoint, over the past 4 days here, it's just been marvelous. The hospitality, the attitudes, the recovery is truly shining through. New Orleans has really come up to the task. It's been wonderful.

Dr. Frohlich: Thank you.

Dr. Schwartz: Ed, why present this talk?

Dr. Frohlich: I was asked to talk about the lessons learned from Hurricane Katrina. Disasters are a problem we face throughout the world. Whether it's a major hurricane, a storm, a tornado, a riot, or — God forbid — another 9/11, we are not prepared for this in any country. We are not prepared for the massive devastation that can occur. Yet, there is no group of people who should be more interested and concerned about this lack of preparedness than physicians in general and cardiovascular physicians in particular.

I'm participating in a session called Stress and Cardiovascular Disease. Stress affects everything. We're interested in cardiovascular disease, of course, but it's March 2007 and it's 19 months since the storm in New Orleans and people are still stressed by the problem.

Dr. Schwartz: If planning reduces stress, what types of planning should we do?

Dr. Frohlich: First, make a list of what you should bring with you when you have to leave your home: medications, your medical records, important telephone numbers, and insurance policies. That's very important. Most insurance companies will respond when you tell them you are in a devastated area. The issue then is getting the reimbursements and the settlements, which can be very, very slow.

We in medicine have talked for so long about the importance of paperless records. If our institution did not have paperless records, our patients who left New Orleans and went to Baton Rouge and elsewhere in Louisiana would have had no medical records. However, for the parishes in that area we happened to have a hospital across the lake and clinics there. So, all of my patients had their records available. I don't know how many physicians around the country have practices with paperless records that someone can link to in another city, but that really helps in an emergency.

Dr. Schwartz: Speaking of paperless records, I was talking this morning to Dr. Paolo Ragi, who as you know was at Tulane University School of Medicine and runs the imaging center there. The entire patient record system, every image, was wiped out because the backup system was on the ground floor that was flooded.

Ed, on a personal level, tell us about the evacuation.

Dr. Frohlich: I've lived in this city for over 30 years and whenever there was a hurricane evacuation, my wife and I would go to the Hyatt Regency hotel 10 minutes away and ask for a room on the lowest floors. The hotel was kind enough to offer a concierge floor much higher up, but that would not have been the right thing to do.

Dr. Schwartz: Why?

Dr. Frohlich: If they lose power you've got 30 flights of stairs to climb. Fortunately, we were able to stay either on the 6th or 7th floor above the garage level. So we checked in that Sunday morning early, and my wife and I went into our hotel room. I brought my papers; I thought I could take my manuscripts and work on them. And our plan was that the next day, or whenever the mayor would call the emergency over, we'd be home in 10 minutes. That's what always happened.

Well, that evening, everyone in the hotel was told to evacuate to a third floor exhibit hall where there were no windows, and bring a pillow plus whatever papers or valuables you have. We didn't bring much; we didn't anticipate we'd be there that long. About 1,000 people joined us, lying on the floor at the Hyatt Regency, and we stayed there for 1 week, without power, without toilet facilities, and with no communications. Cell phones didn't work because the towers were not available. So, there we were in isolation. A day or two thereafter the flood waters came in from the breach of the levee and we stayed there in that one room for 1 week.

Dr. Schwartz: What went through your mind?

Dr. Frohlich: Certainly, how do we let our family know we're safe? I found one telephone that was being used primarily by the people of the press. I walked around there quite frequently to call our family and tell them we were safe.

Dr. Schwartz: Any personal worries about survival? Any concerns about literally the basics of life?

Dr. Frohlich: Fortunately the hotel had some food stores. They were careful in how much to give out. There was no acute area and some of the 1,000 of us in that room were sick. There were people who belonged to a dialysis program that had to get care. I gave my name as a physician, but I was not called upon for these patients. The mayor and the head of the power company had headquarters there, plus our police were headquartered there, and I would make rounds in the administrative offices just to find out what was going on. That really kept me stable.

Dr. Schwartz: You certainly brought some stunning, horrific pictures. People certainly did not fare so well, for example, right here in the New Orleans Convention Center. Can you talk about what was going on in the city and in New Orleans hospitals?

Dr. Frohlich: There was a misinterpretation by the press who suggested there were no hospital facilities available. There were emergency facilities brought in eventually by the National Guard and the military, but there were three major hospitals, too, in Jefferson Parish, which is part of the greater New Orleans area, and these centers took a big load. At Oschner there was less flooding outside our facilities and we had emergency staff there. And, within a week, they did a heart transplant. We also had our own generators and pumps in our hospital in case of an emergency and we had a very good administrative staff that supported the physicians.

Dr. Schwartz: Getting back to your early comments about planning and the importance of it; it sounds like that worked pretty well from an Oschner standpoint.

Dr. Frohlich: Yes, and we had paperless records, which helped a lot. Something I would strongly recommend to...

Dr. Schwartz: With backups I'm sure.

Dr. Frohlich: Unfortunately, I lost four textbooks I was working on. I didn't have backups at home. I had backups on tapes, but all my backups were in the same room as my computer, so they were lost.

Dr. Schwartz: Oh my goodness. From a cardiovascular experience standpoint, any increased incidence of myocardial infarction?

Dr. Frohlich: When we looked at the total number of people who came to the emergency room, the percentage change in patient numbers was not great until Chris White, the head of our cardiovascular department, broke the data down and we could see there was an increase in MI.

Dr. Schwartz: What about the psychiatric unit and post-disaster trends in diagnoses and visits?

Dr. Frohlich: I can give you only one piece of data that I was fortunate to get from Dr. Joseph Guarisco, who heads our emergency department: prior to Katrina we saw about 100 psychiatric diagnoses a month. We are now seeing somewhere on the order of 325 to 350 psychiatric diagnoses a month.

One problem with giving you data relates to the tremendous number of volunteers who came to help out. Medical schools sent teams down. Unfortunately, there are few data regarding who they saw and what they saw in terms of diagnoses. They were so overloaded they couldn't keep the records that would help us in planning for future disasters.

Dr. Schwartz: Much has been made on the national level about failure of the support systems — the federal government, FEMA, state, city, the insurance carriers. What's your personal perspective on that?

Dr. Frohlich: A total lack of planning. This was clearly the worst disaster that the United States has ever sustained, so our federal government was not able to anticipate such massive devastation, but nevertheless, people of New Orleans are still battling with the government. There were different and conflicting plans for disbursing money to rebuild homes that were not worked out between the federal government and the state. Then there are the insurance issues: hurricane insurance does not cover flood damage. If you have a hurricane and a flood ensues, you're not covered. Insurance companies will insist you had flood damage not hurricane damage. Until rather recently, we weren't able to recover our insurance money and we had no recourse except threat of a lawsuit.

Dr. Schwartz: Finally, what are the lessons learned?

Dr. Frohlich: First, have a plan and review your plans frequently. Patients should talk with their physicians and physicians should talk to their patients. Do you have enough medicines? Do you have enough cash to take with you? Do you know where you will go if you must leave the community? How are you going to communicate when there are no cell phone towers? How are you going to contact an individual? These are issues we need to anticipate and the only way to do it is for medicine to take a leadership role and make plans that relate to our patients, our hospitals, our offices, and our other practices.

Dr. Schwartz: Our congratulations to you and God bless you and all the other inhabitants of this city who made it through the tragedy and whose spirit survived. The city is coming back.

Dr. Frohlich: Thank you for this opportunity and thank the College so much. This took a lot of courage to bring the ACC meeting here; it could have been moved after the hurricane. However, because Steve Nissen insisted that the College come here, this meeting has done so much for the city. And certainly, for those of us who are members, it is remarkable to see that the College came through for us and the city.

Dr. Schwartz: Thank you, Ed.


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