Coping with calamity. How well does health care disaster planning work?

On August 17,1969, Hurricane Camille, the most destructive North American hurricane since 1937, made landfall on the Gulf Coast. The storm devastated coastal Mississippi, Louisiana, and Alabama and inland areas in the South. It killed between 250 and 400 people and caused damage estimated at $1 billion, a stunning sum at the time. The 25th anniversary of that catastrophe is cause enough to ask how much has been learned about disaster planning since; but the United States and its health care system have had several more recent unfortunate opportunities to consider the question. Among these trials have been Hurricane Andrew in south Florida on August 24,1992; Hurricane Iniki on the Hawaiian island of Kauai on September 11,1992; massive flooding in the Midwest in the summer of 1993; and the Northridge earthquake in the San Fernando Valley of southern California on January 17,1994. In each case, health care facilities suffered problems—in