What are the 2 major planning failures pre-event at Memorial that led to it becoming a disaster?

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What are the 2 major planning failures pre-event at Memorial that led to it becoming a disaster?
At what point during the 5 days at Memorial do you think the most psychological harm occurred?
Who (doctors, patients, responders, family) do you think experienced the most mental health impact of how the response/evacuation at Memorial was handled? Why?
If you were on staff at Memorial during this disaster would you have done anything differently?
As a future emergency manager, what changes/plan would you implement for Memorial? Why?

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