Analyze

“ After extensive hurricane damage fueled in part by a warmer atmosphere and warmer, higher seas, communities in Texas are considering ways to rebuild more resilient infra- structure. In the U.S. Caribbean, govern- ments are developing new frameworks for storm recovery based on lessons learned from the 2017 hurricane season.” (34)

“​​However, Harvey’s total rainfall was likely compounded by warmer surface water temperatures feeding the direct deep tropical trajectories historically associated with extreme precipitation in Texas, and these warmer temperatures are partly attributable to human-induced climate change. Initial analyses suggest that the human- influenced contribution to Harvey’s rainfall that occurred in the most affected areas was significantly greater than the 5% to 7% increase expected from the simple thermodynamic argument that warmer air can hold more water vapor. One study estimated total rainfall amount to be increased as a result of human-induced climate change by at least 19% with a best estimate of 38%, and another study found the three-day rainfall to be approximately 15% more intense and the event itself three times more likely.” (95)

“​​For example, in the Nebraska part of the northern High Plains, small water-table rises occurred in parts of this area, and the net depletion was negligible. In contrast, in the Texas part of the southern High Plains, development of groundwater resources was more extensive, and the depletion rate averaged 1.6 km3/year.” (160)

“In the Southeast (Atlantic and Gulf Coasts), power plants and oil refineries are especially vulnerable to flooding…Nationally, a sea level rise of 3.3 feet (1 m; at the high end of the very likely range under a lower scenario [RCP4.5] for 2100) (for more on RCPs, see the Scenario Products section in App. 3)47 could expose dozens of power plants that are currently out of reach to the risks of a 100-year flood (a flood having a 1% chance of occurring in a given year). This would put an additional cumulative total of 25 gigawatts (GW) of oper- ating or proposed power capacities at risk.48 In Florida and Delaware, sea level rise of 3.3 feet (1 m) would double the number of vulnerable plants (putting an additional 11 GW and 0.8 GW at risk in the two states, respectively); in Texas, vulnerable capacity would more than triple (with an additional 2.8 GW at risk).” (180)

“The Southern Great Plains, composed of Kansas, Oklahoma, and Texas, experiences weather that is dramatic and consequential. Hurricanes, flooding, severe storms with large hail and tornadoes, blizzards, ice storms, relentless winds, heat waves, and drought—its people and economies are often at the mercy of some of the most diverse and extreme weather hazards on the planet. These events cause significant stress to existing infrastructure and socioeconomic systems and can result in significant loss of life and the loss of billions of dollars in property.” (991)

“With the Gulf of Mexico to its southeast, the coastal Southern Great Plains is vulnerable to hurricanes and sea level rise. Relative sea level rise along the Texas Gulf Coast is twice as large as the global average, and an extreme storm surge in Galveston Bay would threaten much of the U.S. petroleum and natural gas refining capacity.” (992)

“The Southern Great Plains ranks near the top of states with structurally deficient or functionally obsolete bridges, while other bridges are nearing the end of their design life.16,17,18 Road surface degradation in Texas urban centers is linked to an extra $5.7 billion in vehicle operating costs annually (dollar year not reported).15 The region has tens of thousands of dams and levees; however, many are not subject to regular inspection and maintenance and have an average age exceeding 40 years.” (995)

“Along the Texas coastline, sea levels have risen 5–17 inches over the last 100 years, depending on local topography and subsidence (sinking of land).25 Sea level rise along the western Gulf of Mexico during the remainder of the 21st century is likely to be greater than the projected global average of 1–4 feet or more.26 Such a change, along with the related retreat of the Gulf coastline,27 will exacerbate risks and impacts from storm surges.” (996)

“Superimposed on the existing complexities at the intersection of food, energy, and water is the specter of climate change. During 2010–2015, the multiyear regional drought severely affected both agricultural and aquatic ecosystems. One prominent impact was a reduction of irrigation water released for the Texas Rice Belt farmers on the Texas coastal plains, as well as a reduction in the amount of water available to meet instream flow needs in the Colorado River and freshwater inflow needs to Matagorda Bay.” (997)

“The 2017 Texas State Water Plan52 indicates that the growing Texas population will result in a 17% increase in water demand in the state over the next 50 years. This increase is project- ed to be primarily associated with municipal use, manufacturing, and power generation, owing to the projections of population increase in the region.”  (1001)

[See Edwards Aquifer case study on pg. 1002.]

“Between 1982 and 2012, 82 dams failed in Texas, and during 2015 the high-hazard Lew- isville Dam was of concern due to observed seepage.” (1005)

“Within Texas alone, 1,000 square miles of land is within 5 feet of the high tide line, including $9.6 billion in current assessed property value and homes to about 45,000 people. Sensitive assets include 1,600 miles of roadway, several hospitals and schools, 4 power plants, and 254 EPA-listed contamination sites (hazardous waste and sewage).100 Up to $20.9 billion in coastal prop- erty is projected to be flooded at high tide by 2030, and by 2050, property values below the high-water mark are projected to be in excess of $30 billion, assuming current trends of greenhouse gas emissions.” (1005)

“Saltwater intrusion of aquifers has been observed in the Gulf Coast Aquifer, the second most utilized aquifer in Texas, which supports 8 million people. Although this was in part associated with heavy pumping, the Gulf Coast Aquifer remains vulnerable to further saltwater intrusion resulting from SLR and storm surge exacerbated by climate change.” (1006)

“In August 2016, a historic flood resulting from 20 to 30 inches of rainfall over several days devastated a large area of southern Louisiana, causing over $10 billion in damages and 13 deaths. More than 30,000 people were rescued from floodwaters that damaged or destroyed more than 50,000 homes, 100,000 vehicles, and 20,000 businesses. In June 2016, torrential rainfall caused destructive flooding throughout many West Virginia towns, damaging thousands of homes and businesses and causing considerable loss of life. More than 1,500 roads and bridges were damaged or destroyed. The 2015–2016 El Niño poured 11 days of record-setting rainfall on Hawai‘i, causing severe urban flooding.” (67)

“Increases in baseline sea levels expose many more Gulf Coast refineries to flooding risk during extreme weather events. For example, given a Category 1 hurricane, a sea level rise of less than 1.6 feet (0.5 m)47 doubles the number of refineries in Texas and Louisiana vulnerable to flooding by 2100 under the lower scenario (RCP4.5).” (181)

“Many urban locations have experienced disruptive extreme events that have impacted the transportation network and led to societal and economic consequences. Louisiana experienced historic floods in 2016 that disrupted all modes of transportation and caused adverse impacts on major industries and businesses due to the halt of freight movement and employees’ inability to get to work. The 2016 floods that affected Texas from March to June resulted in major business disruption due to the loss of a major transportation corridor.147 In 2017, Hurricane Harvey affected population and freight mobility in Houston, Texas, when 23 ports were closed and over 700 roads were deemed impassable.” (498)

“​​Communities in Louisiana and New Jersey, for example, are already experiencing a host of negative environmental exposures coupled with extreme coastal and inland flooding.” (548)

“An example of the effects of rising sea levels can be found in Louisiana, which faces some of the highest land loss rates in the world. The ecosystems of the Mississippi River Delta provide at least $12–$47 billion (in 2017 dollars) in benefits to people each year.155 These benefits include hurricane storm protection, water supply, furs, habitat, climate stability, and waste treatment. However, between 1932 and 2016, Louisiana lost 2,006 square miles of land area (see Case Study “A Lesson Learned for Community Resettlement”),211 due in part to high rates of relative sea level rise” (775)

“The flood events in Baton Rouge, Louisiana, in 2016 and in South Carolina in 2015 provide real examples of how vulnerable inland and coastal communities are to extreme rainfall events.” (785)

“Hurricane Harvey was a Category 4 hurricane on the Saffir–Simpson scale when it made landfall on the central Texas coast near Rockport late in the evening of August 25, 2017. It then moved inland, stalled, and eventually moved back over the coastal Gulf of Mexico waters before making landfall a final time as a tropical storm several days later in southwestern Louisiana.” (992)

“The State of Louisiana’s Coastal Protection and Restoration Authority’s 2017 Coastal Master Plan has more than 100 struc- tural and coastal restoration projects designed to provide benefits over the next decade and up to 50 years into the future.” (1320)

“Louisiana’s Comprehensive Master Plan for a Sustainable Coast has five broad objectives: reduce economic losses from flooding, promote sustainable coastal ecosystems, provide coastal habitats that support commerce and recreation, sustain the region’s unique cultural heritage, and contribute to the regional and national economy by promoting a viable working coast. The plan contains actions  that advance all five objectives, reflecting a set of tradeoffs broadly acceptable to diverse communities in the face of hazards, including coastal subsidence (sinking land) and sea level rise.” (1323)

Ch. 23, Southern Great Plains (Texas): This chapter provides five (four listed below) key messages about the climate of and climate change in the southern great plains region:

1. Food, energy, water resources - Changes in water supply due to climate change are intersecting with changes in water demand due to food, water, and energy consumption. 

2. Infrastructure - the built environment is vulnerable to climate change. Along the gulf coast of Texas, sea level rise in the coming years is a major concern. 

3. Ecosystems and ecosystem services - aquatic ecosystems are impacted by extreme weather events. Not all aquatic species can adapt. 

4. Human health - Increased temperatures that cause disease transmission and an increase in extreme events that cause injury and displacement are projected in the coming years. 

Ch. 19, Southeast (Louisiana): This chapter provides four (two listed below) key messages about the climate of and climate change in the southeastern U.S.:

1. Urban infrastructure and health risks - Cities in the southeast are particularly vulnerable to heat, flooding, and disease risk due to climate change. 

2. Increasing flood risks in coastal and low-lying regions - Low lying regions are susceptible to flooding due to extreme rainfall and sea level rise.

The Emergency Medical Treatment and Labor Act is a law requiring that anyone coming into the emergency department will be stabilized and treated no matter what their insurance situation is. In terms of women's health, it is important to note that this means for active labors, medical treatment is necessary and required, no matter the health insurance of the patient. The purpose of this law to prevent certain patients from being turned away in an emergency situation or refused medical treatments if they are unable to pay, putting their health at risk.

EMTALA was enacted by Congress in 1986 and was part of the Consolidated Omnibus Budget Reconciliation Acts of 1985. Congress saw different cases around America where doctors were refusing medical care to patients who could not make a deposit at the time of their admittance to the ER. An example of this is a patient Eugene Barnes, who in 1985 suffered a stab wound and ultimately ended up dying because 6+ doctors refused to help him without payment or some form of compensation. This made national news and other cases began to come to light, such as at Baptist Hospital in Miami and many other areas. News outlets began to follow these cases and this caught attention of government officials. Shortly after, EMTALA was enacted.

http://www.pitt.edu/~kconover/ftp/emtala-draft.pdf

This policy applies to American law and patients who are in need of emergency medical treatment and is to be followed by all emergency departments and personnel alike. 

This was touched upon a little in a previous question. Many cases of patient dumping were popping up around America. Patients in need  of emergency medical care were being cast aside, ignored and delayed due to their inability to pay. In addition to the stab patient, Eugene Barnes that sparked this law, there were dozens of other cases where patients needed to be transferred to larger hospitals but the hospital refused to take patients without insurance, so the patients died. There were cases of people being asked right before surgery for a deposit, and being unable to pay were discharged with no surgery. There was also a very high rate of dead babies that were arising due to the fact that mothers in labor were being turned away because the patient was uninsured. It was then realized by the government that there were no legal duties for a hospital to treat people who are in emergency situations but cannot pay, only ethical and moral duties, which apparently weren't enough in some cases. This led to the birth of the EMTALA, requiring medical attention to all ED patients as well as transfers if needed to stabilize, including mothers in labor.

This policy greatly helped sculpt emergency medicine and public health. By giving the right to the patient to have emergency medical treatment required without proof of insurance or payment, astronomically influenced the amount of patients being turned away and their possibilty of developing worse illnesses or dying. In a paper I read, a young doctor in the late 70s and early 80s remembers watching a woman in labor give birth in the doorway of the hospital and proceed to borht her child in the parking lot after being turned away for not having insurance. By requiring hospitals and doctors to see that all ED patients get care, no patient was at risk of dying or complicating their baby's health and birth due to a lack of insurance, ultimately increasing public health efforts. Not all hospitals turned away their patients, but enough did to make it a public health concern and get Congress involved. EMTALA changed emergency medicine protocols but also public health expectations and actions.

http://www.hhnmag.com/articles/5010-the-law-that-changed-everything-and…

This policy was explicitly made for vulnerable populations who couldn't afford or for whatever reason did not have health insurance. The vulnerable parties that did not have health insurance were at risk of being turned away at hospitals during crucial times of need and emergency situations. This act completely absolved the worries and fears of this vulnerable population without health insurance by making it a law that these ED patients were to receive care and stabilization. This act was made for this specific vulnerable population, to prevent discrimination.