Hurricane Katrina proved to be an epic lesson in preparedness. From the individual level all the way to the highest levels of the federal government, failures to plan and mitigate ended in disaster. We are still learning lessons from that terrible storm in August of 2005. A recent book, Five Days at Memorial by Sherri Fink, is one of the more gut wrenching efforts to document what can happen when disaster strikes. Health care professionals at New Orleans’ Memorial Medical Center faced the ultimate nightmare scenario. They were left to decide those they could help and those they could not help. The last remaining back-up electrical generator had failed. Emergency batteries providing the last hope for life support equipment had nothing left to give. There is no question that everyone involved in those terrible hours were heroes in their attempts to provide for the patients. Building maintenance personnel performed extremely dangerous procedures attempting to keep power going in the building. Doctors and nurses did everything possible to save their sickest patients. But it was not enough.

The word “mitigation” is thrown around a lot. But it is an important word and concept. So many of the problems seen at Memorial Medical Center could have been mitigated either by building design or by more effective management practices. With the number of flooding disasters in recent years, those involved with building design and operation should understand the folly of placing critical infrastructure below grade. Back-up electrical generators will not run underwater. Oh, but it has never flooded at that location. All that can be said is that it has not flooded there yet. Mitigation moves that critical infrastructure above flood levels. It is important to remember that floods are not always related to a storm event.

A different maintenance routine and generators designed for long term use could have delayed some of the problems. Running a generator for a short time once a month is not enough as they found out. Weekly start-ups and then, longer 24 hour runs under load once a month might have revealed problems with the system before it was needed. That is what mitigation is all about. Finding problems and solving them before a procedure or piece of equipment is needed.

Five Days at Memorial is not a light read. In fact it can be painful. But it is full of lessons for all of us who plan for disasters. I am mentioning the book only from the standpoint of emergency preparedness. A lot of the book delves into the ethics of euthanasia and the medical personnel involved in a controversial way.