Acadian Ambulance Got It Done

What we don't yet know about the response (or lack thereof) to Hurricane Katrina in New Orleans will doubtless fill volumes over the next several years. What we do know is this: Acadian Ambulance Services did it right. We're not just saying this because we had the foresight to present them with the EMS Magazine 2005 Gold Award at EMS EXPO just two days before Katrina hit (but we don't mind mentioning it). Their light shone so bright in that first dark week that the whole country noticed.

Based in Lafayette, LA, about 120 miles west of New Orleans, Acadian is the largest private ambulance company in the nation and was dubbed by John Tierney of the New York Times "a lonely island of competence" in the chaos and confusion that engulfed the area. TIME Magazine noticed it, too, pointing to CEO and Chairman of the Board Richard Zuschlag's example of "acts of heroism [that] took the form of mini-rebellions against the bureaucracy."

THE BEST LAID PLANS...
"We started evacuating nursing home patients several days before the hurricane was expected," says Ross Judice, MD, the company's medical director, who a few days later would become known as the guy who took the bull by the horns at the Superdome, coordinating medevac operations with a Disaster Medical Assistance Team (DMAT) situated at the New Orleans Arena next door and helicopters from the National Guard, the Coast Guard, the Army, and numerous private air ambulance companies. Acadian took around 700 patients out of harm's way before the storm arrived. Most nursing homes have mutual agreements with other facilities around the state for such situations, he explained, but hospitals don't tend to evacuate. "They figure they're in big structures and they've got generator power," he says. "They'd been through it before; they figured they'd just ride the storm out."

The New Orleans emergency plan was to use the Superdome and the Arena to shelter patients with special needs who had not been able to leave on their own and as a "shelter of last resort" for the general population.

"The special-needs shelter is run by the New Orleans Health Department in conjunction with the Louisiana Department of Health and Hospitals (DHH)," explains Judice.

There were representatives from the New Orleans Health Department there, including director Julette Saussy, MD, who had lost her own home and dogs; and from DHH, including the secretary of DHH, Fred Cerise, MD, MPH. They were responsible for the special-needs patients and had the Louisiana National Guard Medical Team supporting them.

"They're good people," says Judice, "but without their infrastructure, they were overwhelmed."

As for the general population, they would be given a bottle of water and a bag of MREs twice a day. In terms of medical care for them, however, "I don't think the city's emergency operations plan calls for anybody to be in charge," Judice says. "Basically, they were saying: If you're going to come to the shelter, bring your own medications. The medical care of the general population, by default, fell to us."

Acadian is not a 9-1-1 provider for New Orleans, but they have a contract with the Superdome/Arena complex, handling medical needs that arise at events such as concerts, Saints football and Hornets basketball games.

"Because of our relationship with the Superdome, we felt it was important to have some of our staff there," says Judice.

This plan involved sending Ray Bias, RN, EMT-P, the company's governmental relations manager for the city of New Orleans and member of the board of the National Registry of EMTs (NREMT) and its former chair (1990-91 and 98-99), and "allaround problemsolver," according to Judice, to set up a little Aid Station "like we would at any event."

Bias was at the Convention Center, like most of the region's and thousands of other emergency responders, for EMS EXPO and scheduled to head over to the dome early Sunday morning. His buddy from way back, NREMT's Executive Director Bill Brown, decided to go with him, along with a group of six Acadian paramedics and some ambulances. Their first job was to help the National Guard triage and check in those special- needs patients.

"The city and the state believed that the dome would take in about 200 special-needs patients," says Bias. "But by the end of the day we had 400 or 500 of these folks, plus a couple hundred more who needed to be transported to hospitals in the area. But for some reason, all the other providers in the area starting leaving-they shut down about 4 p.m. on Sunday and ceased transporting. We still had about 100 or so patients that needed to go to higher-level facilities. I had asked eight or 10 of our people from surrounding areas-Houma, Covington, Baton Rouge-to come and pick up some of our units and take them out of harm's way. When they got there, this Homeland Security guy came up to me and said he was commandeering my people and my ambulances to transport those patients."

It was 10 p.m. before they finished and the Acadian "volunteers" were able to head for home, by which time the wind had started to pick up, making big box rigs a danger on the road. "We were very concerned about them getting home safe," says Bias, who kept in touch with them by cell phone. "They all made it back by the grace of God."

INSIDE THE SUPERDOME
Bias, Brown and their small team, and two remaining ambulances parked outside, proceeded to set up a provisional Aid Station outside the company's existing first aid closet at the Superdome. They fenced off a clinic area with a few free-standing steel barricades in "an area no bigger than 10' x 20', if that, when you had the door open," with supplies that consisted of "basically some ACLS drugs and bandages," says Bias. People from the general population would come up to the Aid Station's barricade and ask for what they needed. "But we didn't have much." Among those who found the Aid Station were nine medics who had been stranded at the EXPO from South Dakota, Ohio, New York and the Army, and got themselves to the Superdome for shelter. They volunteered to join the Acadian team, and Bias was happy to have them.

As for special equipment, the EMS team had Acadian's two golf-cart-like transport vehicles, called "Gators," used for football games. These would come in handy in the following days. Eventually they were also able to get their hands on several cots from the National Guard, which they lined up in the Aid Station as well. They had not brought special radios or medical equipment with them, since everyone expected they'd go home as soon as the storm quit, like they had the year before during Hurricane Ivan, says Bias. But that didn't happen as everyone knows now. For more, see the sidebar In the Dome.

COMMUNICATIONS MADE THE DIFFERENCE
As luck would have it, Acadian's cell phones, with the Lafayette area code, continued to work throughout the storm, enabling Bias to remain in contact with sources outside the area-though not with New Orleansbased officials in the dome or the city. In addition, the radios in their ambulances were able to communicate with Acadian's dispatch center in Lafayette. Through these channels, arrangements were made for relief and supplies to be flown in on Tuesday by helicopter.

When Judice arrived, along with IVs, oxygen and albuterol treatments, AccuCheks and insulin, he also brought a portable communications center borrowed from the sheriff's office of Lafayette's neighboring town New Iberia; satellite phones from Bell South to enable communications with the outside world; and radios so the EMS team could communicate among themselves, calling for a Gator to pick somebody up and bring them to the Aid Station, for example.

But Judice soon realized that while people were still coming in, no one was being evacuated: "I wanted to know who was in charge here. I'd just flown in on a helicopter; surely we could evacuate people by helicopter."

Bias took him down to the landing zone, where DHH had their command center. But they were focused only on evacuating patients from state hospitals, which were now surrounded by water.

So Judice put his phones to work. "I called our air services on the satellite phone and our guy says there are two helicopters sitting on the helipad. 'I'll even give you their tail numbers!' Sure enough, there are two private air medical helicopters from PHI (Petroleum Helicopters Incorporated) that had come at the request of Acadian, a pilot on each one, with a nurse and a paramedic, and I introduce myself and they say, 'Yeah, there was some guy from the state who said he would be right back, and that was two hours ago.'

"That was it. I said, 'Okay, we're taking charge of this.'''

Then he went next door to the Arena, where a DMAT team from New Mexico had arrived and set up a medical zone, but they weren't interested in the patients in the Superdome.

"I grabbed some people in charge over there and dragged them over to our Aid Station and said, 'Look, this is what we're doing.' They understood the situation immediately. I put Ray Bias with a radio in the DMAT zone, a radio in the Aid Station, another one on the Gator in the Superdome, and I had a radio. We all started working together. DMAT did the heavy lifting with the critical patients. We began to move patients out by helicopter."

ALL HANDS ON DECK
For Acadian it was, in Judice's words, "all hands on deck." Medics to mechanics jumped into the fray, delivering supplies, cooking and keeping generators working. Some of these people had also lost their homes. A triage area was set up in Metairie out on Interstate-10 at Causeway Boulevard, six minutes from New Orleans by helicopter. Ambulances from all over came and lined up on the highway to receive patients and transport them to hospitals in Baton Rouge and elsewhere as fast as PHI could medevac them. Then PHI ran out of flight hours.

At that point, Judice went "with hat in hand" to an Army colonel in charge of some Blackhawks delivering supplies, who also agreed. But it still wasn't going fast enough. So he called Zuschlag. "I said, 'Richard, we have got to have helicopters to evacuate these medical patients.' And he said, 'Well, how many do you need?' And I said 'All of them, I need every helicopter you can send over here.'

Wednesday morning, the first helicopters that arrived were Acadian's, bringing replacement staff that included doctors, nurses and paramedics. Those helicopters went back out immediately with critical patients aboard. "Around 9 o'clock," Judice says, "they just started flying in like bees swarming: Coast Guard helicopters. Army Blackhawks. National Guard Blackhawks. Civilian helicopters. We just shuttled them out of there as fast as we could."

Not just out of the Superdome, but out of New Orleans' hospitals, as well, which were by now literally swamped, and out of supplies as well as generator power.

Judice and Acadian's team of EMS providers on one end, with Zuschlag on the phone with folks like John Matessino, president/CEO of the Louisiana Hospital Association on the other, as well as their families, friends and associates who answered the call, spent the next three days getting patients out of the flooded city by air, boat and truck. They moved the Aid Station outside the Superdome, then integrated it into the DMAT center at the Arena, which took over medical care of the general population. Then they triaged stretcher and walking patients at the DMAT center, created a staging area at the landing zone of 15-20 patients, and in groups of four per aircraft-two walking and two on stretchers-patients from the VA, Charity and Tulane hospitals, and the Superdome/Arena were evacuated.

"Once we got that little system going, we were flying them out fast," says Judice.

By Wednesday night, hundreds of patients had been evacuated. Bias had gone home, slept a day and come back on Friday to facilitate the evacuation of Charity Hospital, talking truck drivers with four empty 18- wheelers into helping, which speeded things up considerably. All told, over 5,000 patients and about 11,000 hospital staff and family members were evacuated by the weekend.

"Acadian's culture has always been to 'Get the job done,' says Judice.

"'Take care of your patients, and you'll be supported if you make sound clinical judgments,' That's Richard's message as CEO and that's my message as medical director. Things happen because you have good people wanting to do good things who have the leadership and the motivation to do it. We saw a need and stepped up. That happened over and over again."