4 2014 draft br health district framework final lowres

BATON ROUGE HEALTH DISTRICT Vision framework

Health /

A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

Health district /

A place where a community comes together to achieve their unique public health goals.

Baton rouge health district / The place where Baton Rouge comes together to achieve health goals and collaborate for greater successes in the new future of healthcare.

ABOUT This DOCUMENT / Why do we plan? A plan is an attempt to model the future and establish a tangible link between a desired future and our actions in the present. Planning is necessary, at some level, in all decision making. For Baton Rouge, planning is key to improving the health of its people and its economy.

In 2011, FuturEBR, East Baton Rouge Parish’s comprehensive master plan, identified the South Baton Rouge Medical District as one of city’s most essential growth areas. In 2013, The Baton Rouge Area Foundation hired Perkins+Will, a pioneering design firm in the emerging field of health districts, to develop a plan to enhance and harness that growth for the good of the community.

This document, a Vision Framework, is the first step towards an action plan. It outlines a vision for the Baton Rouge Health District—a place-based health collaborative that will support the vitality of its members and deliver health and economic development benefits to Baton Rouge and beyond. At the heart of this vision is a robust analysis of emerging trends in the U.S. health industry, and a high-level assessment of existing opportunities that will serve as the foundation for future planning.

With this guiding vision and the implementation that follows, we believe the Baton Rouge Health District will be positioned to thrive as a durable asset to the community and a model for the future of healthcare.

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AT A GLANCE /

1 2

HEALTH DISTRICT What is it and why do we need one?

Health, Healthcare and Communities

Collaboration and Health Districts

Five Scales 1. District Core

2. District Network 3. City

Baton rouge Where are we today and how will we measure progress?

4. The Super-Region 5. The State

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Baton rouge Health district How do we create a place that supports overall health?

One Vision: HEALTH

A Place

A Mechanism

A Brand

A State of Mind

The Way Forward

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HEALTH DISTRICT What is it and why do we need one?

The definition of health is changing.

Obesity-related chronic conditions now account for more than 75% of all healthcare expenditure in the United States. But the tide is turning for our nation’s health outlook. People and institutions around the nation are making gains to improve health by addressing environmental factors that are increasingly linked to better health outcomes.

What makes us healthy? It’s more than healthcare.

10% 20%

CLINICAL CARE

GENETICS

20% 50%

ENVIRONMENT

HEALTHY BEHAVIORS

Behavioral factors such as diet and physical activity, and the environmental factors that impact those behaviors account for as much as 70 percent in overall health impact.* *Bipartisan Policy Center, June 2012.

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Healthcare is also changing: It’s moving into the community.

The high-cost of treating chronic diseases is also transforming the business of healthcare. Healthcare providers are looking “outside of the box” for ways to prevent and manage disease in lower cost, community-based settings.

The Continuum of Care Model

The Expanded Quality of Life Model GREATEST $$$ NARROW IMPACT INSTITUTIONAL FOCUS

ACUTE CARE

PREVENTATIVE CARE

ICU ED Inpatient Specialist Rehab care Primary care Mental health Healthy behaviors Social connectedness

LOWEST $$$ BROAD IMPACT COMMUNITY FOCUS

QUALITY OF LIFE

Productivity + satisfaction MEDITATION + FAITH LIGHT, LAUGHTER, FRIENDSHIP, FRESH AIR

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We’re going to have to work together to solve these problems.

No one entity alone can improve the health of a population. All resources must be harnessed: everybody has a role to play and benefits to gain.

Where are the opportunities to collaborate?

SOCIAL SERVICE ORGANIZATIONS

SCHOOLS

PARKS DEPARTMENT GOVERNMENT

UNIVERSITIES

HOSPITALS

RESEARCH CENTERS

FOUNDATIONS

INSURANCE COMPANIES RECREATION CENTERS

BUSINESSES POLICE

DEVELOPERS

COLLEGES

PRIVATE CLINICS NEIGHBORHOOD ORGANIZATIONS

RELIGIOUS ORGANIZATIONS

COMMUNITY CENTERS

BATON ROUGE IS UNITED TO ADDRESS COMMUNITY HEALTH CHALLENGES. The Mayor’s Healthy City Initiative, now in its sixth year of existence, has brought together over 40 health organizations under its umbrella to improve the health of Baton Rouge citizens. The Initiative has a strong focus on obesity-prevention, supported by projects promoting healthy eating and active lifestyles. The Baton Rouge Health District builds on this movement and the city’s rich history of civic stewardship.

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We need a place to collaborate.

We need a district.

In the future, medical districts will be more than destinations for healthcare.

They will be healthy places to heal, work and live where new ideas on improving healthcare and population health can be developed, tested and distributed.

What does the future look like?

2014

MEDICAL DISTRICT Healthcare Destination

2030

HEALTH DISTRICT Support for Overall Health Vision

Focus on Healthcare Excellence

Focus on Health Excellence + Holistic Healthcare Delivery + A Balanced Mix of Health-Supporting Uses and Programs

Healthcare Delivery Model High Acuity Care Volume-Based Fee-for-Service

Continuum of Care + Public Health Value-Based Outcomes Rewarded

Shared Resources Specialty Healthcare Clinical Research Residency Programs

Specialty Healthcare Clinical Research Residency Programs + Streamlined Support Services + Health Data Warehouse + Translational Medicine + Health-Supporting Environments + Community-Focused Health Education + Health Policy Leadership

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Baton rouge Where are we today and how do we measure progress?

Welcome to baton rouge, 2014.

What happens here matters.

Baton Rouge is a microcosm of the health issues facing cities across the nation.

The Baton Rouge Health District can be a living lab for change, with a ripple effect far beyond its core. With the right partnerships and collaboration, small gains can be replicated and amplified. But in order to create a platform for change, we must understand where we are today, identify the needs and opportunities, and set high expectations for the future.

The Baton Rouge Health District is defined by the needs and opportunities at 5 scales:

1.

The District Core

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2.

The District Network

3.

The Baton rouge Metro area

4.

The Southeast Super-region

5.

The State of Louisiana

The district core / The need to create a healthy built environment.

PENNINGTON BIOMEDICAL RESEARCH CENTER, 234 acres

The District core has an insufficient transportation network with few access points. Its car-oriented built environment is unsafe for pedestrians. There is limited access to the remarkable green space amenities located within walking distance.

MAJOR DESTINATIONS

6

1

5 3

rd

4

Ess en ln

Pe rk in s

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2

Perkins road Community park, 52.2 acres

7 8

future rail station

Future creek trail

PRELIMINARY INDICATORS

intersections

are located within a 1/4 mile in the district core.

Acres of Park Land

6.4

acres

of park land are available per 1,000 residents in Baton Rouge.

1. Pennington Biomedical Research Center 2. Baton Rouge Clinic 3. LSU Medical Education and Innovation Center 4. Our Lady of the Lake College 5. Our Lady of the Lake Regional Medical Center 6. Mary Bird Perkins Cancer Center 7. Baton Rouge General Medical Center — Bluebonnet Campus 8. Ochsner Medical Center — Baton Rouge 9. Future Children’s Hospital

HOW WE’LL MEASURE PROGRESS

Intersection Density

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The district core has a large concentration of pillar healthcare institutions, as well as many private practices, physicians’ groups and other businesses.

LSU burden center, 440 acres

25-30 intersections are typically located within a 1/4 mile.

13.8

acres

is the median amount of park land per 1,000 residents in similar metropolitan areas.

Intersection density Sidewalk coverage Pedestrian / bike accidents Acres of public open space % Of fast food restaurants % Transit coverage Parking demand Diversity of land uses Diversity of business types Housing units

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The core District, and the broader area surrounding it, are home to a large number of competing healthcare providers that operate independently. Information exchange and transportation connectivity is key to increased collaboration and coordination of patient care across systems.

the DISTRICT NETWORK / The need to connect strong institutions.

OCHSNER MEDICAL CENTER

BATON ROUGE GENERAL medical center — mid-city

OUR LADY OF THE LAKE REGIONAL MEDICAL CENTER LSU RESIDENCY PROGRAMS

BATON ROUGE GENERAL medical center — BLUEBONNET TULANE RESIDENCY PROGRAM

Pennington biomedical Research center

Blue cross blue shield of la WOMAN’S HOSPITAL The neuromedical center

PRELIMINARY INDICATORS

HOW WE’LL MEASURE PROGRESS

Electronic Health Records (EHR) Adoption

15% of Baton Rouge hospitals have adopted ehrs.

37% 89% is the national average for ehr adoption.

adoption rate achieved in St. Paul, Minnesota.

average daily traffic (ADT)

42,690 21,800 cars per day travel on Essen Lane.

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cars per day travel on Brookline Ave, the main arterial serving the medical district in Boston, Massachusetts.

% ehr adoption % data shared % resources shared cost per patient transportation funding transit ridership street level of service average daily traffic % ARRIVING BY CAR travel time

Residents in the Baton Rouge Metro Area and East Baton Rouge Parish suffer from high rates of preventable diseases and have unequal access to care. As providers of healthcare, health education, and employment in the community, healthcare institutions are critical partners for change.

the BATON ROUGE METRO AREA /

The need to improve the health of area citizens.

Baton rouge metro baton rouge metro area

East baton rouge parish

Areas with highest socioeconomic barriers to health Community Need Index (CNI) measures economic and structural barriers to overall health by zip code.

A high CNI score indicates severe socio-economic barriers and has also been correlated with high hospital and emergency-room use.

CNI: 4-5

CNI: 3-4

CNI: 2-3

CNI: 1.6-2

PRELIMINARY INDICATORS

HOW WE’LL MEASURE PROGRESS

medicare beneficiaries with diabetes

29% 28% of Medicare patients in Baton Rouge have diabetes.

16%

of Medicare patients in is the lowest rate Louisiana have diabetes. of diabetes seen among states.

emergency room utilization (per 1000 beneficiaries)

749

visit Baton Rouge ERs each year.

Baton rouge health district

646

is the national average for ER utilization rates.

431

Obesity Rate Prevalence Of Chronic Diseases HIV rate mortality rates Primary Care Access Community needs indices Inpatient Utilization Rate Emergency Room Utilization readmission rates

is the lowest rate seen in the U.S. 17

Healthcare and educational institutions in Baton Rouge and New Orleans are moving towards greater collaboration, which is key to a high-performing health education that meets population health needs. Regional collaboration is also essential for disaster preparedness.

the SOUTHEAST SUPER-REGION /

The need to support regional resiliency and collaborative health education.

Baton rouge health district 1.

new Orleans biodistrict

Louisiana State University

2.

Our Lady of the Lake College

3.

Pennington Biomedical Research Center

4.

Baton Rouge Community College

5.

Baton Rouge General School of Nursing

6.

Southern University

New Orleans biodistrict

State government Baton rouge health district

1.

LSU Health

2.

Tulane University

3.

Delgado Community College

4.

Dillard University

Proposed passenger rail

PRELIMINARY INDICATORS

HOW WE’LL MEASURE PROGRESS

Disaster Response

200,000 Residents

came to Baton Rouge in the immediate aftermath of Hurricane Katrina

200% SURGE IN POPULATION

clinical trials (2009-2014)

384

number of clinical trials held in Baton Rouge

18

725

number of clinical trials held in New Orleans

1,224

number of clinical trials held in Birmingham, Alabama

clinical trials research grants INTER-INSTITUTIONAL PROGRAMS CROSS-DISTRICT PARTNERSHIPS allied health education inter-city travel time

the STATE OF LOUISIANA /

The need to diversify the health economy and create jobs.

Louisiana lags behind the nation in efficient healthcare delivery which threatens its ability to adapt to the future of healthcare.

The super-region, and Baton Rouge in particular, need to adopt new modes of healthcare delivery and attract health-related businesses to gain a competitive edge.

Birmingham UAB medical center Dallas Southwestern medical center

Baton rouge / new Orleans

Houston

Baton rouge health district

Texas medical center

New Orleans biodistrict

PRELIMINARY INDICATORS

HOW WE’LL MEASURE PROGRESS

Accountable Care Organizations (ACOs)

2

number of acos located in the state of Louisiana.

14%

of the us population is now served by an Accountable Care Organization.

HEALTHCARE cost savings acos new business investment jobs CREATED health it jobs created

Preventable Healthcare Costs

2x more

hospital stays in Louisiana are preventable as compared to the national average.

$77 million

could be saved every year by reducing hospital readmissions to the level of the best performing state.

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Baton rouge HEALTH DISTRICT How do we create a place that supports overall health?

Many needs, one vision: It’s all about HEALTH. Baton Rouge is ready to leverage its healthcare assets for the benefit of overall health—healthy people, healthy communities, and a healthy economy.

Working together, we have a tremendous opportunity to improve lives and chart a new future for Baton Rouge.

the baton rouge health district will be:

A PLACE / For connecting the dots.

A MECHANISM / For getting things done.

A BRAND / For shifting perceptions.

A STATE OF MIND / For shifting culture.

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HEALTH

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The Baton Rouge Health District is

a place /

For connecting the dots.

The District is, above all else, a physical place. It has a defined boundary and a broader area of influence.

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working together we can Transform the district core into a healthy place

that supports the health needs of all its users, from healing to walking for daily exercise.

build a vibrant public realm

that serves and unites District community students, researchers, employees, patients, visitors, medical staff and residents.

build physical connections

that improve access to care and facilitate collaboration between district institutions.

promote sustainable growth

that adds value to the District, improving the safety and efficiency of daily operations.

Suggested Strategies Facilitate Movement

++ Transportation demand management ++ Enhanced transit access ++ Multi-use urban river trail (CAPP Medical District Loop) ++ District shuttle expansion ++ Pedestrian and bike friendly streets ++ Bike/car share and carpool programs ++ Accessibility improvements ++ Improved signage and wayfinding

Implement Quality of Life Enhancements

++ Walking-distance amenities ++ Increased density and diversity of uses ++ District housing options ++ District magnet school ++ Passenger rail and transit-oriented development

Provide Access to Nature

++ Connected network of parks, ecological reserves and trails ++ Healing landscapes ++ Open space and trail programming (“Walk with a doc�, fun runs) ++ Outdoor fitness facilities

Build Resilient Infrastructure

++ Connected street network ++ District-wide energy ++ Underground utility tunnels ++ Wetland and stream restoration ++ Green streets

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The Baton Rouge Health District is

a mechanism / For getting things done.

The District will be a partnership of organizations with well-defined processes for shared visioning, planning and decision-making.

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working together we can find a common voice that highlights shared goals.

build a culture of collaboration

that encourages competitors to make shared business decisions that save resources and build capacity.

Build an outreach platform

that engages the community in health promotion and disease prevention and builds public support for health-promoting projects located within the District.

implement positive change

that furthers our shared goals, improves the health of the community and generates economic development.

Suggested Strategies Develop Shared Vision and Goals

++ District land use, open space and transportation plans ++ District zoning and development guidelines

Create Shared Authority

++ Health District Organization ++ Clinical Trials Consortium ++ District Design Review Committee ++ Regional Health Information Organization

Raise Funds for Implementation

++ Health Improvement District ++ Tax-Increment Finance District ++ Public-private partnerships ++ State and federal grants (MediFund, LED grants)

Share Resources

++ Patient data warehouse (health information exchanges, data analytics) ++ Shared support services (1-800-NURSELINE, linen services, medical transport) ++ Shared procurement ++ Shared facilities (Post-acute treatment, flexible research / educational spaces) ++ Shared emergency response

combine outreach efforts

++ District website ++ Participatory planning processes ++ Patient and caregiver training programs ++ Health education programs ++ Workforce training programs

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The Baton Rouge Health District is

a brand /

For shifting perceptions.

The District will have a strong identity that is recognizable in all its communications, and is reflected in its physical environment.

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working together we can Become recognizable

Attract new partners

Grow the market

Bring positive attention to baton rouge and Louisiana

to gain a competitive edge in attracting new talent to Baton Rouge.

to treat more Baton Rouge patients at home and to attract patients from beyond Baton Rouge.

who can bring ideas, energy and investment into the District and its organization.

by generating and distributing valuable knowledge and success stories about health that emerge out of Baton Rouge.

Suggested Strategies Develop Brand Standards

++ District name and logo ++ District identity standards ++ District website

Leverage Regional Assets

++ Joint advocacy with New Orleans BioDistrict ++ Local Food / Farm Partnerships

Create a Unique Sense of Place

++ Branded signage and wayfinding ++ Public health amenities (signature trails, outdoor fitness stations) ++ Health programs (charity/fun runs, yoga in the park) ++ Health-themed public arts

Build on Baton Rouge Culture

++ Downtown connections ++ LSU connections ++ Healthy Cajun and Creole cuisine ++ Health hospitality

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The Baton Rouge Health District is

a state of mind / For shifting culture.

The District will become a cultural milieu that fosters innovation in teaching, research, and practice.

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working together we can EDUCATE enlightened change agents

who can catalyze transformation of the healthcare community through clinical research and practices that support disease management and prevention.

build a culture of excellence that cultivates and promotes best practices across the District.

advance new technology and products that lead to successes in population health management and generate economic development.

Become a living laboratory

where pilot projects are implemented and evaluated to build the knowledge-base of health-promoting strategies.

Suggested Strategies Build High-Performing Health Education Programs

++ Interdisciplinary health-related degrees ++ Clinical-based learning environments ++ Clinical scholars program

Support Clinical Research

++ Clinical Research Consortium ++ Clinician-scientist recruitment ++ Clinical scholars program ++ Industry partnerships

Measure Progress

++ Employee health census ++ District performance indicators and metrics ++ District annual report

Support Health-Related Business Development

++ Organizational partnerships (BRAC, LSU Innovation Park, Louisiana Economic Development) ++ Angel funding for start-ups ++ Healthcare IT incubator ++ Business and networking events

Promote Best Practices

++ District magazine / blog ++ Social media ++ Annual conference / symposia ++ Grants, awards and scholarships

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we have great aspirations.

IT’S TIME TO TAKE ACTION. We have a great community, great opportunities and great aspirations. We also have significant challenges which, if unaddressed, will threaten our ability to meet our individual and collective goals in the future. In more ways than one, our success depends on the strength of our collaboration.

These are the next steps we take together: ++ Identify strong leadership ++ Build a decision-making platform ++ Identify sources of funding for shared infrastructure

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This is where we are.

this is where we’re going.

THE BIG IDEA

CONVENE DISTRICT SPONSORS

TALK TO STAKEHOLDERS

DEFINE VISION and GOALS

ASSESS OPPORTUNITY

ESTABLISH PLANNING FRAMEWORK

IDENTIFY PRIORITIES

IDENTIFY MODELS

IDENTIFY DECISION MAKING PROCESS

IDENTIFY TASK FORCE AND RESOURCES

LAUNCH DISTRICT PLANNING PROCESS

District Timeline

FuturEBR

Health District

Health District

Medical District Idea

Vision Framework

Vision and Roadmap

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acknowledgements This study has been initiated and funded by the Baton Rouge Area Foundation. BRAF would like to thank the following individuals who provided information to the planning team:

Andy Allen, Mayor’s Healthy City Initiative Mike Bruce, STANTEC Sister Kathleen Cain, Franciscan Missionaries of Our Lady Health System Dr. William Cefalu, Pennington Biomedical Research Center Donald Daigle, Our Lady of the Lake Regional Medical Center John J. Finan, Jr., Franciscan Missionaries of Our Lady Health System

Mayor Melvin L. “Kip” Holden, City of Baton Rouge / East Baton Rouge Parish Kathy Kliebert, Louisiana Health and Human Services Department Camille Manning-Broome, Center for Planning Excellence Bob Mirabito, Capital Area Transit System Walter Monsour, East Baton Rouge Redevelopment Authority Stephen Moret, Louisiana Economic Development

Teri Fontenot, Woman’s Hospital

Dr. Steve Nelson, LSU Health

David Guillory, City-Parish Department of Public Works

Dr. Frank Opelka, LSU System

Dr. Lee Hamm, Tulane School of Medicine Ryan Holcomb, City-Parish Planning Commission Dr. Larry Hollier, LSU Health Dr. George Karam, LSU Health Nancy M. Kelly, The Neuromedical Center Adam Knapp, Baton Rouge Area Chamber Jeff Kuehny, LSU Burden Center Carolyn McKnight-Bray, BREC

Mike Reitz, Blue Cross Blue Shield LA Jamie Setze, Capital Region Planning Commission Stanley F. Shelton, Woman’s Hospital Edgar Silvey, Baton Rouge Clinic Mark Slyter, Baton Rouge General / General Health System Todd Stevens, Mary Bird Perkins Cancer Center Elizabeth “Boo” Thomas, Center for Planning Excellence Scott Wester, Our Lady of the Lake Regional Medical Center

Eric McMillen, Ochsner Medical Center, Baton Rouge

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further reading HEALTH AND HEALTHCARE

Accelerating Clinical Trials in Baton Rouge. Baton Rouge Area Chamber, 2012.

CONNECT Medical District Policy Forum: Key Findings Report. CPEX. 2013.

Frenk J, Chen L, et al. Health Professionals For A New Century: Transforming Education To Strengthen Health Systems In An Interdependent World. The Lancet.

2010.

Gregory, Don and Alison Neustrom.

New Safety Net: The Risk And Reward Of Louisiana’s Charity Hospital Privatizations. The Public Affairs Research Council of Louisiana. 2013.

Lots to Lose: How America’s Health and Obesity Crisis Threatens our Economic Future. Bipartisan Policy Center. 2012.

Louisiana Report Card on Physical Activity and Health for Children and Youth. Pennington Biomedical Research Center, 2012.

Mayor’s Healthy City Initiative.

Annual Report. 2013.

National Healthcare Quality Report.

Agency for Healthcare Research and Quality. 2012.

Partnership for Sustainable Health Care: Strengthening Affordability and Quality in America’s Health Care System. Robert Wood Johnson Foundation. 2013.

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Report on Louisiana Healthcare Delivery and Financing System. Price WaterHouse Coopers, 2006.

Richardson, James A. Hospitals and the Louisiana Economy. Louisiana Hospital Association. 2011.

Richardson, James A. The Potential for Medically-Related Research as an Economic Driver in The Greater Baton Rouge Area. Baton Rouge Area Foundation, 2008.

The Greater Baton Rouge Community Health Needs Assessment. Mayor’s Healthy City Initiative. 2012.

The State of US Health: Innovations, Insights and Recommendations from the Global Burden of Disease Study.

Institute of Health Metrics and Evaluation: University of Washington.

2013.

Zuckerman, David. Hospitals Building Healthier Communities: Embracing The Anchor Mission. The Democracy Collaborative at the University of Maryland. 2013.

BUILT ENVIRONMENT and transportation

Baton Rouge – New Orleans Intercity Rail Feasibility Study: Strategic Business Plan. Regional Planning Commission. 2014.

Complete Streets Work Group: Final Report. Louisiana Department of Transportation and Development.

2010.

Danger Zones: A Summary Of Pedestrian Fatality Trends In Louisiana. CPEX. 2014.

FuturEBR: A Vision for East Baton Rouge Parish. City Parish Planning Commission, 2011.

Imagine Your Parks 2: BREC Strategic Plan. Forthcoming. 2014.

Jackson, Richard J. Design­ing Healthy Com­mu­ni­ties. Wiley, John & Sons, Inc. 2011.

Louisiana Speaks Regional Plan: Vision and Strategies for Recovery and Growth in South Louisiana.

Louisiana Recovery Authority. 2007.

The Burden Center Master Plan. LSU. 2009.

The Built Environment and Health: 11 Profiles of Neighborhood Transformation. Prevention Institute.

2004.

Walk and Ride: A Resource Guide to Funding Pedestrian, Bicyle + Complete Streets Projects in Louisiana. Center for Planning Excellence. 2013.

Baton Rouge MTP: 2037 Metropolitan Transportation Plan.

Capital Region Planning Commission, 2013.

ECONOMY

Capital Area Pathways Project: Wards Creek Trail Conceptual Plan. BREC. 2012.

Comprehensive Economic Development Strategy. Capital Region Planning Commission. 2012.

BRAC’s 2014 Strategic Plan: Opening Doors. Baton Rouge Area Chamber.

2014.

Elaine Ortiz and Allison Plyer.

Economic Synergies Across Southeast Louisiana. Greater New Orleans Community Data Center, 2013.

Louisiana’s Southeast SuperRegion: Unprecedented Partnership, Unprecedented Success. Baton Rouge Area Chamber / Greater New Orleans Inc. 2012. disaster-preparedness and resilience

Annual Report FY 2012-2013.

Louisiana Emergency Response Network.

Carbonell, Armando, and Douglas Meffert. Climate Change and the Resilience of New Orleans: The Adaptation of Deltaic Urban Form.

Lincoln Institute of Land Policy.

2009.

Hollier, Larry. The Impact of Hurricane Katrina on Louisiana State University Health Sciences Center New Orleans. Testimony for the United States Senate. 2006.

Hurricane Katrina in the Gulf Coast: Mitigation Assessment Team Report.

FEMA. 2009.

Guin, Cecile C et al. Health Care and Disaster Planning: Understanding the Impact of Disasters on the Medical Community. Office of Social Service Research and Development, Louisiana State University. 2008.

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