A Deadly Season

When disaster strikes, Americans turn to their emergency services. They look to law enforcement to restore order, the fire service to save property and lives, EMS to provide speedy medical assistance. But what happens when those emergency personnel are every bit as impacted by a community’s misfortune as those they’re sworn to help?

Civilians and emergency providers alike experienced that dilemma last summer in Florida. And then they experienced it again…and again…and again. They experienced it four times, in fact, as a series of powerful hurricanes raked the Sunshine State over a tumultuous six-week span.

The hurricanes in Florida wrecked stationhouses alongside residences and businesses; kept ambulances and engines off the roads; and visited personal destruction on the homes and families of the EMTs and firefighters toiling to assist others in similar need. Physically, emotionally and by any other barometer, it was a trying time to be an EMS professional.

“People were on edge,” says Lori Recca, who faced two of the storms head-on as EMS division chief for Stuart Fire and Rescue, which serves a hard-hit town of 15,000 between Fort Pierce and West Palm Beach on the Atlantic coast. “Our people did a great job, but it was hard. They were working so many hours, then they were going home and trying to deal with their own issues, their own homes, their own families.”

The Stuart area was hit twice—first by Frances, then again, three weeks later, by Jeanne.

“With the first storm, I was without power in my own home for 12 days,” says Recca. “With the second, I was without power for three. That was a common thing for many people. They would stay with their friends or relatives, or whatever they had to do.”

And they would work. Following storms of this magnitude, no matter your personal circumstances, there’s plenty to be done.

Charley

The first of the hurricanes was Charley. The strongest of the four upon arrival—in fact, the most powerful hurricane to make landfall in the U.S. since Andrew in 1992—Charley was Category 4 (Category 5 is the strongest under the Saffir-Simpson Hurricane Scale), with winds approaching 150 mph, when it arrived at the barrier islands off Cape Coral, adjacent to Fort Myers on the southwest coast, on August 13. It followed hot on the heels of Tropical Storm Bonnie, which had hit the state’s panhandle area just 36 hours earlier. It had been 98 years since two storms had hit the state so close together.

Charley’s landfall brought a seven-foot storm surge in Fort Myers, and storm tides (the combination of normal tide levels plus storm surge) up to 13 feet above mean sea level along parts of the southwest coast. Charley proceeded across the state, crossing Orlando and emerging around Daytona Beach—with sustained winds still around 70 mph—some eight hours later.

The hurricane wreaked major havoc upon Lee and Charlotte counties before weakening as it moved inland. Charlotte County Fire-EMS saw damage to seven of its 13 stations, as well as its main headquarters.

“Station No. 1, which is our busiest station, right in the central part of town, was pretty much totally destroyed,” says department spokesperson Dee Hawkins, EMT-P. “Station No. 12 suffered a tremendous impact; the roof in the bay came off. Station No. 7 was a total loss. And there were other minor damages to some of the stations—windows being blown out, things like that—and our main headquarters took a bit of a hit too.”

After making sure their apparatus was fully fueled and stocked—part of the department’s normal preparations when a hurricane approaches—Charlotte providers rode out the storm in the department’s newer stations, which are rated to withstand stronger winds than some of the older ones, which leaders had already been looking to replace. Personnel huddled under mattresses, away from windows, and kept in radio contact.

Once the storm passed, crews quickly emerged to begin rescue operations. They were met by an apocalyptic scene: Roofs missing, trees down, roads blocked. With few street signs surviving, officials painted street names directly onto the pavement to help guide incoming mutual-aid crews.

“We were fortunate that our people are in permanent stations, so they know their zones pretty well,” says Hawkins. “But we had a lot of mutual aid come in from other counties, so we manned their apparatus with people from our department to help with directions.”

The post-storm process was a group effort. Public works got out quickly to clear the roads, and power-company personnel worked to restore power.

“Florida Power & Light are my heroes,” says Hawkins. “They worked very hard with the power lines, getting them up, getting them out of the way, getting power into those areas as quickly as possible.”

While phone service was down, radio communications, with the exception of one tower, survived largely intact.

In the aftermath of the storm, calls more than doubled, from an average of fewer than 100 a day to around 200. Contributing factors included Florida’s stifling summer heat and the trauma that predictably follows hurricanes.

“Because of the time of the year, it was very hot, with very little breeze,” says Hawkins. “And with the power outages, people didn’t have air conditioning. So they were out in their yards, trying to clean up and do repairs, and we saw a lot of heat exhaustion and heat stroke. And we had falls—people trying to put tarps on their roofs and falling off. We saw fractures and cuts. There were a couple of chainsaw incidents involving people cutting up debris.”

Another post-storm issue was a distinctly human one: With the department’s headquarters damaged, the exposed items inside were ravaged by looters who helped themselves to vital equipment, including computers.

“Our main headquarters used to be a fire station, and so toward the front is a bay area that we utilized for storing bunker gear, personnel uniforms, hoses, couplings, that kind of thing,” says Hawkins with a wry laugh. “We lost a lot of uniforms. People came in and took them. We had some bunker gear disappear, helmets, things like that. It was kind of funny; we’d be traveling around town and see someone wearing a Charlotte County Fire-EMS T-shirt, and we’d realize, That’s not one of our people!”

Frances

Three weeks after Charley, Frances rolled into the Stuart/Jensen Beach area early on the morning of September 5. It was considerably weaker than the previous storm—winds estimated at 105 mph made it a Category 2—but moved much more slowly, meaning lengthier exposure to wind and rain for those in its path.

Frances plodded west-northwest across the state, taking nearly 19 hours to reach the Tampa area, where it was downgraded to a tropical storm. It then moved into the Gulf of Mexico, before swiping Florida a second time near Tallahassee.

The storm brought severe flooding as a result of its slow pace and heavy rainfall (10"–14" in Volusia County from September 3–6; 5"–8" over most of the rest of east-central Florida). “Virtually all rivers” in west-central and southwest Florida flooded by September 9, according to the state’s Division of Emergency Management.

On Florida’s east coast, as on its west, departments know the drill when a major storm is looming.

“We have a checklist for the last 72 hours,” says Recca. “We make sure all of our stock is at full capacity or ordered, and we have it shipped overnight. We get all of our oxygen filled and make sure we have everything topped off and ready to run.”

Easy enough in Stuart, which has two stations. The county in which Stuart lies, Martin, with a population of almost 130,000, faced a somewhat larger task in getting ready.

“There are several things we do,” says Joe Ferrara, chief of Martin County Fire-Rescue’s EMS Bureau. “Part of it is decentralizing our operations. With the thought that post-storm, we’re going to be cut off in communications and resources, we split our county up into four divisional EOCs. Each one of those, from a field standpoint, is self-functioning. We stock up additional medical supplies, personnel and equipment resources at each one of those locations, so that post-storm, they can go out and function by themselves.”

As in Charlotte County, not all of the firehouses in Martin County withstood the storm’s ferocity. Four of Martin County Fire-Rescue’s 12 stations had to be evacuated, as did Stuart’s main station, which lost part of its roof.

“We had to pack up everything we own and get into shelters,” recalls Recca. “There are 40 of us, so we split up into three groups. One went to a hospital, one went to a church, and one went to Southern Bell’s building. We were there for five days before anyone went home.”

Wary of potential damage to community hospitals, Martin County authorities had prestaged their disaster field hospital, a 25-bed field triage and minor-treatment facility that can be deployed anywhere in the county and set up in short order. When Frances finally passed, this gave them a leg up on dealing with the aftermath.

“We know that transporting patients may be difficult due to trees and power lines being down and the roads being blocked,” says Ferrara. “If we deploy this facility to the worst-hit areas, then we can at least provide field triage and basic ALS treatment, and hopefully we can treat and release some patients, as opposed to overloading the local hospitals. In fact, in our case, one of our hospitals lost part of its roof and had its ED flooded, so after the storm, we were basically down to one hospital.”

Knowing that 9-1-1 isn’t likely to be functioning after a major storm, Martin County, like many departments in the state, has a plan for actively seeking out those needing assistance. Crews from each station go out as a team, in a rescue truck or ambulance and a fire engine, and cover the county in grids, going house to house and making sure everyone’s OK.

Priority is given to those who called 9-1-1 before the phones went down. Since crews are pulled off the roads and stations locked down when winds reach a certain speed, these callers simply have to wait out the hurricane. That’s not a preferred way of doing business, of course, but provider safety requires it.

“We had pending calls, so obviously the mission was to go to those locations first,” says Ferrara. “We did find some fairly critical patients who had been waiting out the storm at their houses—difficulty breathing, cardiac patients and things like that.

“We also have a special-needs shelter that stressed our resources quite a bit. Part of the roof came off, and they had to move all the special-needs patients into a safer area of the shelter. We staged an ALS rescue unit at that shelter, and I can tell you, after the storm, they were one of the busier units in the county, getting those patients out of there. A lot of those patients were deteriorating.”

Many of the logistical difficulties seen in Charlotte County recurred in Martin. Foremost among them was communications.

“We didn’t lose radio contact, but we could only use our simplex channels,” says Recca. “We could use our 800 just for local calls, without a repeater. So we weren’t being dispatched, and we just kind of went through the EOC. Another thing was, through Frances, we found that we had problems with our cell phones, so the department gave us U.S. Cellular phones too. So we had 800 radio, VHF radios for backup and cell phones. But there were a lot of times it was really difficult to communicate, just because of everything being knocked down.”

In the days after Frances, as Charlotte providers experienced after Charley, came the trauma calls.

“Lots of people falling off roofs, trying to get their shutters down,” says Ferrara. “A lot of chainsaw injuries from people trying to cut trees down. A week post-storm, the call volume was way up with all the traumatic cases. Everybody was out there getting hurt.”

Ivan

Florida’s panhandle, already victimized by Bonnie and Frances, absorbed another blow when Category 3 Ivan barreled through on September 16. Bringing winds estimated near 130 mph and storm tides of 10´–15´, Ivan made landfall near Gulf Shores, AL (roughly 15 miles west of the state line), then moved north-northeast, eventually weakening to a tropical storm by the time it reached central Alabama.

Ivan was thought to be the most destructive hurricane to hit Baldwin, Escambia and Santa Rosa Counties in more than a century. It caused flash floods and tornadoes, and partially collapsed the Interstate 10 bridge over Escambia Bay when water pushed sections of the roadway off their supports and into the bay. In some places, up to 16 inches of rain fell in 48 hours.

Like their colleagues in other coastal areas of the state, providers with Escambia County EMS, which serves Florida’s westernmost county, monitored the storm’s progress and made the preparations they could.

“We pull vehicles and personnel off the road when we believe it’s not safe anymore, and we try to obtain that information from the crews,” says Gary Straughn, the department’s operations chief. “In Escambia County, you may have pretty strong winds in the south end, while toward the north end of the county they haven’t picked up quite as much yet. We found we could continue operating for a short time in the north end of the county even after we shut down in the south end.”

With leaders ensconced at a central Emergency Operations Center, field personnel and apparatus were dispersed to some of the department’s regular posting locations that had generator backup—fire stations, hospitals, etc.—to facilitate responses once the storm passed; medics were also stationed at a special-needs shelter. Then both EMS and fire/rescue went out of commission for roughly 12 hours over the night of September 15. When they emerged on the morning of the 16th, they were greeted by a wreckage that was by now painfully familiar to state officials and those watching on TV.

“It was true devastation everywhere you looked,” says the department’s medical director, Charles Neal, DO. “There were roads blocked, trees down, power lines and poles down, debris in the roadways. It took an extensive amount of time to reach some of the calls simply because there was no way to get to them.”

Calls still waiting from the night before were prioritized and answered. As in the other stricken counties, they featured things like abdominal pain, difficulty breathing and, of course, trauma. “Even late into Wednesday evening (the 15th), we were receiving cell calls reporting vehicle accidents,” notes Straughn.

As in the other stricken counties, a wave of home-repair trauma followed the hurricane.

“Those calls become typical starting 2–3 days after the storm,” says Neal. “Initially, we had a backlog of medical calls—abdominal pain, pregnancy, chest pain—from people who were affected or frightened by the storm, or were separated from their medications or oxygen or breathing treatments, those sorts of things. But shortly after, because of the devastation—the number of trees down and the amount of damage to homes—the number of traumatic injuries got to be fairly large.”

Escambia providers also encountered an unusual adversary in Ivan’s wake: angry bees.

“One thing I hadn’t seen before was the bees and insects that were displaced from their homes,” says Neal. “We started getting calls from crews that they wanted to dispense Benadryl and that sort of thing because they were seeing so many bee stings—many more than we would normally see on a given day. The insect population had apparently lost their nests and were out there stinging and irritating people.”

Jeanne

Barely a week after Ivan, the areas battered by Frances were blasted again when Jeanne, a Category 3 storm, came ashore just before midnight on September 25. Winds were initially around 120 mph. The bad weather moved northward over the next 24 hours, but storm tides largely coincided with low tides, sparing coastal areas some damage.

Jeanne moved west-northwest, nicking Hillsborough County (Tampa) as it weakened to a tropical storm. After it was downgraded, the storm continued up around the “Big Bend” area and passed east of Tallahassee. Its greatest impact came in Brevard and Osceola Counties, which got 11"–13" of rain from Sept. 25–27.

Still reeling from Frances, the Stuart and Martin County areas took it on the chin again. Stuart personnel were still in temporary housing. FEMA had provided them a facility after Frances, but it wasn’t sealed properly, and when the remnants of Ivan circled back around and dumped heavy rains on the area in mid-September (between Frances and Jeanne), “it totally destroyed the brand-new trailer they’d just brought in,” Recca says. “That left the guys with nothing again.”

Back to the shelters they went. Crews were again spread among three facilities, including a brand-new recreation center that had withstood Frances. This time personnel were there for several weeks.

But at least one aspect of the job was easier the second time around: With the Frances experience so recent, citizens in the area seemed to take the threat of Jeanne a bit more seriously.

“The interesting thing was, we had very few calls throughout Jeanne,” says Recca, “probably because the storms were three weeks apart and landed within two miles of each other—and we were in the eye of both of them—I think people just weren’t messing around. They either left the area, or they were closed up tight at home.”

Fortunately, Jeanne passed more quickly than Frances. Nonetheless, wisdom gleaned from the earlier storm was able to be applied to the second.

For one thing, “You don’t want to burn your personnel out by bringing everybody in, then having them all go out en masse,” says Ferrara. “For the second storm, we left an entire shift at home, with orders to come back in at a certain time. You can’t expect to call them back on the telephone, you know? So that way you have some refreshed crews coming back in to relieve people.”

Throughout Martin County, front-end loaders were staged near fire stations to help clear roads after the storm. But because so many signs, branches and other smaller, lighter debris had been torn free during Frances and subsequently cleared, there wasn’t much left to be blown around by Jeanne.

“All the dead trees and other loose debris from Frances was gone, so whatever broke was going to be major,” says Ferrara. “But we still had some roofs collapse and things like that.”

As with the earlier storm, many of the patients seen after Jeanne were victims of falls, chainsaws and other traumatic mechanisms. And during Jeanne, as during Frances and Ivan, providers encountered an unusual number of mothers giving birth.

“Any medical condition can be precipitated by stress,” notes Ferrara. “During the storm, we did have a spike in OB patients, because of the pressure changes. I think it was because we were near the eye, where the pressure differential is greatest. And both eyes of both storms passed over our county, within two miles of one another.”

Three Months Later…

Normalcy has been slow to return to the EMS departments affected by the hurricanes of ’04. As the year drew to a close, temporary facilities were still the norm, and the timetable for full recovery had yet to take shape.

“We’re still not back to normal,” sighs Hawkins. “A lot of our people aren’t in stations yet. We have them housed in mobile homes, basically, which is a concern. We’re six months from hurricane season coming around again. As far as running calls, our response times are back to par. One of our most-damaged stations was relocated to an entirely different area, but we managed to keep it in zone, so their response times are affected slightly, but not tremendously. So we’re back in the mode, just not quite where we need to be.”

In Stuart, while 9-1-1 service is operational, phone service had, as of mid-November, not yet been extended to the new fire/EMS quarters.

“When you call our office, it’ll immediately say ‘Hang up and dial 9-1-1,’ because we’re not connected to that service,” says Recca. “City Hall keeps saying ‘You’re going to get a phone,’ but they have to run all new phone lines to all of the trailers out here for both police and fire. So it’s taken a lot of work, and we don’t have them yet. At least people know how to contact us through our cell phones.”

Little things that most in EMS take for granted become problematic in areas ravaged by disaster. With computers and phones down in Stuart through much of September, for instance, state officials could not get word to Recca about a pending relicensure deadline.

“I finally got word through a roundabout source,” she says, “and the first thing they told me was, ‘We don’t have your license information to renew your licenses for your ALS units, and today’s the deadline.’ My mouth dropped to the ground. I told them, ‘I have no phones, I have no fax, and we don’t even know if we’re getting our mail because we’ve moved so many times.’ And they said, ‘Well, that explains why we’ve called so many times and not gotten an answer, and why you’ve not answered the e-mail, and why the fax keeps not going through.’ They said, ‘Well, if you’ll just send a memo today that says you need to reapply, we’ll accept that.’ And so we took care of that—had to go to City Hall and fax it.

“I’m sure they would have been flexible about it, but I guess they kept thinking we were OK, because we’d been responding to calls. They never thought of the fact that we weren’t getting the mail.”

Lessons Learned

Though hurricanes aren’t uncommon in Florida, there are still lessons that can be taken from experiences like those of the summer of ’04. Foremost is that the buildings that house the emergency services need to be strong enough to withstand even the most powerful winds.

“We’re working a new building, and that’s the No. 1 thing,” says Recca. “The fire and police departments should never have to leave their homes.”

Those buildings also must be stocked with enough equipment and supplies to allow their inhabitants to function. After all, who could be more important to a besieged community than its fire and EMS providers?

“Our newer facilities—the ones that were rated for the greatest amount of winds—had 100-kilowatt generators, and they did well,” says Ferrara. “Our older fire stations that had smaller generators were where we had our challenges. You can’t have people coming to work if you don’t have facilities for them. So right now we’re looking at our older facilities and making sure they have the proper generators to run everything, not just emergency lighting. Also, our emergency management is looking at shelters countywide to evaluate the facilities and the generators, because many of the places only had enough generator support to run lighting, and not ventilation and AC systems, especially in the special-needs shelter. When you have that many sick people in one place, it’s probably a good idea to have air conditioning.”

More broadly, there’s always a need for greater resources in such situations. Charlotte providers reported back to work on the Monday that followed Charley’s Friday landfall, but even then, they were still doing without many things.

“People were coming to work who hadn’t had a bath in three days,” notes Hawkins. “There was no power, no water. There was quite a bit of food brought in; local companies were great about that. But we want to find a way to get better resources to our workers. Communications were a problem also, just trying to get information out to people.”

The department approached the communications dilemma by utilizing its local media. Following Charley, it held press conferences twice a day, bringing together all the relevant county department heads and key players like the Red Cross and volunteer services to address key issues. In addition, its public-information team walked the streets, distributing informational flyers with assistance information at places like water stations.

In Stuart, responders devised a new way of refilling home oxygen after Frances and were ready to employ it in the aftermath of Jeanne.

“Through Frances, because it was such a long storm, we were picking up bottles from people who had home oxygen, taking them away and filling them up, using a cascade system, and then taking them back to the residents,” Recca explains. “With Jeanne, we decided we’d fix up a portable system in a truck and make sure the service people could respond with that. We thought that would be helpful in that kind of prolonged situation—it’s something that’s very time-consuming and hard to handle.”

Jeanne’s quicker pace, however, negated the need for that: It had moved on by the time oxygen refills became an issue.

Conclusion

Many other things went well for these impacted departments. Escambia County’s experience, for instance, underscored the value of knowing and collaborating with your neighbors. Its central EOC kept everyone on the same page and functioning relatively smoothly, even in the face of an unusually lethal hurricane that killed 26 in the U.S. That’s the kind of experience and familiarity that pays off when the next hurricane inevitably comes.

“I felt like I learned a lot through the operation of the EOC, and dealing with all the representatives present there,” says Straughn. “It was obvious from the onset that if you needed help, there was somebody in that room who was going to help you. Everyone did a wonderful job, from the road crews to the supply clerks to the supervisors. We had a tremendous amount of mutual aid come in to help, and it was kind of amazing to see how it all actually pieced together and worked.”

Martin County’s divisional EOC plan also worked as intended, and the multiple modes of communications available to Stuart responders kept everyone in the loop. Too, the state’s decade-old disaster response plan served responders well.

“At the time, it seemed to be chaos, but as you look back and evaluate everything, all the tasks were handled,” says Ferrara. “We have a statewide disaster response plan that was developed after Hurricane Andrew, and that certainly got exercised. We’ve gone over it many times, and it works quite well.”

The most central element of such a plan—the people charged with executing it—is one that can’t exactly be planned for. You teach and train for them to rise to the occasion, but until it happens, you never really know how they’ll perform. In Florida, during the stormy September of 2004, they performed admirably.

“The crews were incredible—they worked day after day,” says Hawkins. “A lot of their homes were destroyed, and their families were left without. These men and women were working, functioning, sometimes not leaving for four or five days. I can’t say enough good things about them.”