Katrina Spawns Nightmare for Providers in New Orleans

By any yardstick and for every segment of society, the events that followed EMS EXPO in New Orleans were catastrophic. Healthcare and public-safety providers weren't spared. In many cases, they had front-row seats for one of the largest disasters in American history.

In a squalid and desperate city spiraling toward anarchy in the days after hurricane-fractured levees left 80% of it under water, EMS personnel and physicians trying to help the sick and injured faced bullying, robbery, hunger, illness, gunplay and help that just didn't come.

The levees breached on August 29 as powerful Hurricane Katrina roared ashore just east of New Orleans. The below-sea-level city filled with water from adjoining canals and Lake Pontchartrain, drowning untold numbers in their homes and stranding thousands more. Tens of thousands of refugees collected at evacuation shelters where, without water or power, conditions quickly deteriorated.

As the week progressed and conditions worsened, survivors became increasingly restive, looting erupted, and lawlessness outstripped the ability of decimated law enforcement to control it. Even as survivors waited on rooftops and corpses floated unrecovered down city streets, police officers had to be pulled from rescue operations to try to maintain order. Some reportedly even joined in the looting.

Acadian, Louisiana's largest ambulance service, was tabbed to evacuate patients from hospitals and provide aid for more than 20,000 displaced at the wind-damaged Superdome. Operations there were temporarily suspended after a shot was fired at a military helicopter. Elsewhere, evacuations were happening by air and by boat, but by this time, some survivors had taken up arms and were stealing food and medical supplies. Some reportedly threatened medics; others brandished guns, scaring rescuers away.

"We tried to airlift supplies into Kenner Memorial Hospital late last evening and were confronted by an unruly crowd with guns, and the pilots refused to land," Acadian president Richard Zuschlag told a reporter. "My medics were crying, screaming for help."

Circumstances in the hospitals degenerated rapidly. A nurse who got through to CNN reported that patients on respirators were being bagged by hand when generators ran out of fuel, and that staff were becoming sick. In some cases, sniper fire prevented evacuations. By Thursday, with virtually no food and water and looters pillaging lower floors, EMS advisory board member Dr. Norman McSwain, with an estimated 200 patients at Charity Hospital, pleaded to the media for help. "We've been trying to call the mayor's office, we've been trying to call the governor's office… We are turning to you. Please help us," he told a reporter. Those evacuations resumed the next day.

That was not quick enough to save some patients who died while waiting for help to come. Australia's Daily Telegraph reported that some doctors even euthanized critically ill patients rather than letting them die slowly as conditions deteriorated. "I injected morphine into those patients who were dying and in agony," one physician said anonymously. "And at night I prayed for God to have mercy on my soul."

Every-man-for-himself conditions took hold. Two San Francisco medics who had attended EMS EXPO wrote a much-disseminated account of how an estimated 500 people stranded in the French Quarter scrounged together enough money for buses to get out, only to have the buses commandeered by the military. They were then denied access to already-full shelters and kept from leaving the city on foot by armed officers who turned them away from adjoining Gretna. They camped out on a freeway—until more officers chased them off and stole their food and water.

At their headquarters outside Jackson, MS, top officials with the National Association of EMTs moved immediately to support EMS efforts through the organization's EMS Rescuer and Relief Fund. By the 31st, its Board had authorized an initial donation of $5,000, and $20,000 more was approved the next week.

NAEMT president Ken Bouvier and immediate past president John Roquemore, both Louisianans, were confirmed safe. Other attendees at the NAEMT's annual conference and EMS EXPO, which ran concurrently through August 27, struggled to get out of town before the storm hit. Some didn't, and rode out the hurricane and subsequent flood in the ravaged city. As this issue went to press two weeks later, their stories were only beginning to be told. (Some of them will be featured in this magazine next month.)

Among the casualties was FEMA director Mike Brown. Fiercely criticized for his agency's sluggish response to the disaster, Brown was first replaced in overseeing the response, then resigned three days later. He will be succeeded at the agency by U.S. Fire Administrator R. David Paulison, a 30-year veteran of the emergency services.

A Second Wave of Challenges

As the immediate crisis in the Big Easy ebbed, however, other challenges were only beginning. Acadian, for example, was beginning to grapple with damaged stations and homeless employees. And while the last holdouts in shattered New Orleans were being coaxed out, influxes of refugees taxed systems elsewhere.

"For us, the focus is to keep operations going in the other 80% of our coverage area that wasn't affected by the storm, and to work toward getting the affected areas back," says Acadian spokesman Keith Simon. "We're trying to secure our big station down in New Orleans and make it functional again. Obviously, the population isn't there, so there aren't very many calls to run, but the influx of people into our other coverage areas will increase call volumes in those places. And we have other stations that were hit hard in Slidell, Covington and Pascagoula, MS."

Infrastructure in the area took a vicious beating. With some Louisiana parishes losing their 9-1-1 capabilities, Acadian was working to route their calls through its call center. The company also had at least 50 employees left homeless.

Elsewhere, disease related to the disaster had begun to crop up. E. coli had been confirmed in the New Orleans floodwaters, and cases of cholera and dysentery were being reported by the next week.

Needs and Opportunities to Help

NAEMT has developed a three-pronged strategy for hurricane relief: It's collecting funds for EMS providers in need; organizing rescue and recovery workers through its PHTLS division; and working to set up a program to temporarily house displaced providers in the Gulf region. For the latest on its efforts, see www.naemt.org.

In addition, EMS Magazine's sister publication Firehouse and website www.firehouse.com have created the ADOPT A FIREHOUSE program, aimed at providing relief to fire/EMS departments, providers and families by recruiting departments across the country to "adopt" and support their affected Gulf-area colleagues.

"The intent...is to provide immediate operational support and…a long-term support system of departments helping departments in the months and years ahead," said firehouse.com founder Dave Iannone, vice president of the Interactive division of the media entities' parent company, Cygnus Business Media.

Hundreds of departments and organizations have already signed up, and the effort has the backing of many major fire-service organizations, including the International Association of Fire Chiefs, National Volunteer Fire Council and the National Fallen Firefighters Foundation. For more, go to www.adoptafirehouse.com.

Upcoming issues of EMS Magazine will feature first-person accounts from the frontlines of the response to Hurricane Katrina, plus detailed analysis of the management of this overwhelming disaster.