DOME home blank
Search Dome


Susan Franklin
Katrina’s Lessons
At a recent mock emergency management system tracer, Director of Regulatory Affairs Susan Franklin played the role of Joint Commission surveyor. Franklin, a Baltimore native and former Wilmer nurse, asked expected questions on compliance by the book but then moved into uncharted territory: how her experience as compliance officer at Memorial Medical Center, a 200-bed New Orleans hospital, during Hurricane Katrina has changed her views on compliance and emergency preparedness. On the second anniversary of the nation’s worst natural disaster, Franklin recounts those lessons.


Susan Franklin
“Once the levee broke, every hour spent at the hospital increased mortality odds,” says Susan Franklin.

We took the warnings about Katrina seriously, yet we didn’t panic—we were old hat at hurricanes. Close to 1,000 people—patients and their loved ones, employees’ families, among others—had sought refuge at the hospital.

It started raining on Sunday evening, Aug. 28. The hurricane hit during Monday’s wee hours. We’d lost power and had some trees down, but by late Monday morning, the sky was blue and the sun was shining. Mississippi appeared to have borne the brunt of the hurricane damage. Some staff poured out of the hospital, but I wanted to wait for the all-clear. A few hours later, the levee broke.

I’ll never forget the scene: We were standing in the boardroom, looking out the window. Suddenly a wall of water came rushing down the streets. It was surreal. We thought a bomb must have gone off, causing a tsunami. One by one, as water engulfed cars, alarms went off. That went on for hours. Then, nobody showed up.

Within days, all our power sources had failed. The switches for our backup generators were under water. Our basement filled with water to the ceiling. We knocked out all the glass windows because the temperature had risen to 110 degrees.

We had no power, no running water, no flushing toilets. About nine patients died every day. We ran out of body bags and had to use sheets. We converted the chapel into a morgue. We made cardboard fans and asked everyone to fan patients. People in the community started arriving by foot, wading through chest- to neck-deep water for medical care or shelter.

Surprisingly, things weren’t too chaotic—until day four. We not only had a natural disaster; we had total civil breakdown. First we were threatened, then invaded by armed community members demanding drugs. We had only one security guard with one gun. Luckily, help was on the way.

Helicopters had finally showed up to relocate our patients. Despite being badly damaged, our little helipad, atop our parking garage, became our lifeline. We used all available flashlight batteries to light it up so rescuers could see us.

To get our patients out, we had to knock down walls, from the mezzanine to the boiler room to the garage. We borrowed gasoline from every parked car to fill up our pickup truck. Then we put patients in the back and drove them to the top floor of the parking garage, where a crew was waiting to carry patients up a rickety set of stairs to the roof.

In all, our hospital ordeal lasted seven days. After seeking refuge with friends in Baton Rouge, my husband, daughter and I made our way to family in Baltimore. The trauma we’d endured in New Orleans was so profound that we decided to start anew here. I’m so happy to be back—full circle—and at Hopkins, with such smart, talented people.

We’ll probably never experience a hurricane comparable to Katrina here, but the very same contingencies we should have had in place during Katrina are relevant to any disaster—having ample water on hand, portable toilets, body bags, weapons for security personnel and alternate evacuation plans. We need to be prepared for multiple and escalating disasters, rather than a single, isolated event.

What if, say, the outpatient center were suddenly bombed? This was a scenario Howie Gwon [Hospital and Health System director of emergency management] and I presented at the mock emergency management system tracer. Should we stay in place and defend ourselves or move people out? Lock all the doors? And, as the situation escalates, what could happen in East Baltimore to preclude our getting help?

Joint Commission now has new standards to address these very concerns. They call it an “all-hazards” approach to emergency preparedness. It stresses the need for planning and testing emergency response plans in the event that the local community can’t support the health care organization.

But day to day—whether you’re dealing with a natural disaster, terrorist attack or some other problem—you can’t always get to a computer or manual to make sure you’re in compliance. As surveys approach, everything here gets ramped up. Anxiety levels are too high. Then, when surveyors leave, we become a little too laid back.

I hope to set priorities in terms of risk so we have a continuous, instinctive plan. Otherwise we’re going to make ourselves crazy.

What was most helpful to us in New Orleans was ingrained into the fabric of our being. Though we never could have prepared for Katrina’s devastation, we were hard-wired to cope a little better because we’d endured previous hurricanes and had had frequent disaster preparedness rehearsals, without computers and manuals—just superb code teams. My goal is to help get us in a continuous readiness mode for surveyors and whatever crises may come our way.

—As told to Judy Minkove



Johns Hopkins Medicine

About Dome | Archive
© 2007 The Johns Hopkins University
and Johns Hopkins Health System