By CHERYL WITTENAUER Associated Press Writer Eight months before the devastation of hurricanes Katrina and Rita, an internal Homeland Security Department review warned that the nation was woefully unprepared for a medical disaster and lacked a coherent plan for taking charge of mass casualties. Government medical teams had difficulty coordinating and delivering help during 2004 hurricanes in Florida, said the report obtained by The Associated Press. The report also said there was inadequate planning for dealing with a surge of patients during a disaster like a biological or nuclear attack.It called for creation of a uniformed medical reserve corps, including specialists, fashioned after the National Guard.“The nation’s medical leadership works in isolation, its medical response capability is fragmented and ill-prepared to deal with a mass casualty event and … DHS lacks an adequate medical support capability for its field operating units,” said the report.Homeland Security officials said the problems identified in the Jan. 3 report were in the process of being addressed when the hurricanes hit. Secretary Michael Chertoff was reorganizing his department and created a new chief medical officer to take the lead on preparedness, they said.“I thought it (the report) was a great place to start,” said Dr. Jeffrey Runge, the department’s new medical officer who started his job after Katrina. “Most people in the medical community who are concerned about readiness, preparedness, disaster medicine and so forth felt pretty much the same way.”But the report’s author, St. Louis transplant surgeon Jeffrey Lowell, told AP he doesn’t believe DHS has implemented enough changes yet, and that the current system of volunteer disaster medical teams was “pretty much shot” when called upon to respond to a second disaster after Katrina.Lowell also said he was startled when then-Federal Emergency Management Agency chief Mike Brown strongly rejected the ideas Lowell had proposed earlier this year. “He rejected the methodology, the message, the conclusion and the recommendations,” Lowell said. “He disagreed with every single everything.”Brown, who resigned from FEMA earlier this month amid blistering criticism of his stewardship of the government’s response to Katrina, did not return repeated phone calls to his cell phone seeking comment.Lowell said Brown didn’t want him to give the report to then-Homeland Security Secretary Tom Ridge. But Lowell, who was hired by Ridge to conduct the review, said Ridge heartily welcomed its conclusions and recommendations.“If people want to tweak it, great. Let’s get on with this and move forward quickly,” Lowell said, urging that more recommendations be implemented.Chertoff took over a month after the report was issued and ordered a further review of medical preparedness. He then reorganized the department, creating a new undersecretary for preparedness and Runge’s job.“There are parts of that report that are absolutely unanimous with what the (medical) community has been saying, and other parts of the report that are very specific organizational things that are not really what Secretary Chertoff has in mind,” Runge said.The report, entitled “Medical Readiness Responsibilities and Capabilities: A Strategy for Realigning and Strengthening the Federal Medical Response,” concluded:National Disaster Medical System teams often are deployed without full preparation for the disasters they are handling. “Recent deployments to Florida following the 2004 hurricanes confirmed critical shortfalls in doctrine, training, logistics support and coordination.”It was “imperative” that the department realign its resources and create the job of an assistant secretary of medical readiness.Conflicts in legislation, a presidential directive and the National Response Plan must be reconciled to eliminate overlapping responsibilities and authorities – and questions about who takes charge. “Politically adversarial turf wars between (Homeland Security) and (Health and Human Services) and similar battles between organizational units within DHS threaten DHS’ ability to lead effective medical response in the event of a national medical event.”There is “significant concern” that the government lacks a single coordination point for local emergency medical services in communities.The nation lacks a “systemwide strategy” for handling a massive surge of patients. “The ability to provide care to large numbers of casualties following a major incident remains one of the greater challenges and vulnerabilities,” it said.Elin Gursky, a public health and biodefense specialist at the Arlington, Va.-based think tank, ANSER, said the nation is “quite conclusively” not prepared to protect people from harm and mitigate disasters.“We still don’t know who’s in charge, and until we do, people will hesitate to act. The assumption is that someone else is in charge,” she said.