ed high blood pressure, respiratory infections, and GI infections. Many evacuees needed treatments to control chronic diseases like diabetes and asthma. Dermatitis and other skin conditions, likely caused by exposure to contaminated floodwaters, were common. Many evacuees had acute emotional problems in need of immediate attention, while others had potentially serious psychiatric conditions. Children and the elderly accounted for a large percentage of evacuees, and posed special requirements to ensure their health and safety.

Among the many obstacles encountered was the lack of a system for identifying and registering evacuees in the overall shelter population. In many cases, patients seen at the clinic couldn't be found for follow-up, such as when important test results came back. Another challenge was confirming the credentials of health care professionals volunteering to help at the clinic—some were retired doctors or nurses with expired licenses, while at least one impostor falsely claimed to be a doctor.

The authors hope their experience—the successes as well as difficulties—will prove useful to other communities in preparing the medical response to future disasters. "With adequate planning and organization, supervision and cooperation, resources and leadership, other communities can respond fully and successfully, as did Houston and Harris County in the aftermath of Katrina," they conclude.

In his editorial, Dr. Nusbaum offers a tough critique of the overall public health response to Katrina, which he characterizes as a "debacle." Areas of weakness played out in succession, including the lack of an effective evacuation plan, the inability to provide aid to those left behind in the storm area, the "ad hoc" evacuation process, and the "continued diaspora" of much of the affected community.

Dr. Nusbaum proposes a fundamentally different approach to preparing for mass evacuations in the future, based on the premise t
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