On the Streets With New Orleans EMS

This year we mark the seventh anniversary of Hurricane Katrina. And for the first time since its last fateful visit in 2005, EMS World Expo returns to New Orleans.

In advance of this year’s show, Oct. 29–Nov. 2 at the Ernest N. Morial Convention Center, we dispatched California paramedic and photographer Josh Kennedy, EMT-P, to ride along with New Orleans EMS and capture the sights and scenes of the city today, as it continues its fight to recover, as seen by those on the front lines of its EMS. Here’s what he saw.

The Big Easy

I flew to New Orleans from San Francisco full of anticipation at what I might experience. It would be a great professional opportunity to ride with and photograph the New Orleans EMS system. I had no personal experience with any EMS system outside of mine in Alameda County, where I’ve served for nine years, the last five as a paramedic. I didn’t know exactly what my two-day journey would yield besides amazing pictures, but what better way to experience any new city than through the lens of a camera traveling Code 3?

I expected to have a good time. I didn’t expect to be touched so much by the dedication, hospitality, positive attitudes and consistently great customer service of NOLA EMS. I was told of the personal and professional tragedies faced by all during Hurricane Katrina. I saw the work that’s been done, and still needs to be done, to restore this wonderful city. I was amazed at how common positive attitudes were as I interacted with the city’s chiefs, doctors, paramedics and EMTs. Despite their ongoing daily struggles, they continue to aid others with the highest quality of service every day.

On my first day I rode with New Orleans native and Deputy Chief Ken Bouvier. Ken made me feel right at home as I climbed into his Ford Explorer. Right away he began telling me, with great pride, of his city’s EMS statistics and geography. NOLA EMS serves 199 square miles of city and cares for a population of approximately 344,000 people. They run around 50,000 9-1-1 calls a year, averaging 180 a day. Of 11 hospitals in the area prior to Katrina, only seven remain. These hospitals are continually overrun with patients, leaving crews “on the wall” waiting to transfer care.

Ken showed me areas that are coming back and areas that are still suffering. Walking around the fence that sealed it off, I was saddened by the empty slab of concrete where the NOLA EMS building used to be. In the Lower Ninth Ward, an area famously devastated by Katrina, I was amazed that its fire station now is a wheeled trailer with an engine parked next to it. In that same area, Ken showed me a memorial consisting of blue poles of increasing height—from about 1 foot to 8—to symbolize the different water heights in that area. There were also chairs placed in this memorial to represent people’s inability to sit on their front porches and look out.

Ken pointed across the street to a fence with a water-line stain about two feet from the ground. He said the water was much higher than that for a short time, but stayed at that two-foot level for weeks, causing that line. I saw many rebuilt homes that still had the old cement steps in their front yards. Those steps were the only things left on homeowners’ properties after the flood. They don’t serve a functional purpose now, but I guess they’re a reminder of the past. Ken pointed out boarded attic openings of homes where trapped residents called for help during the flooding—the only parts of their homes not submerged. Later, as we responded to a call downtown, Ken noted the helipad of a nonoperational hospital where he and his coworkers ate and slept during the floods. He also marked various places on the freeways where fires were started so people could stay warm. I was humbled by stories of starvation in a city known for its fine dining. I never believed starvation could happen in any city in this country, with all our modern amenities and accessibilities.

Our final stop was at the Katrina Memorial. I was honored to be there with an important member of NOLA’s EMS community. Ken told me the large concrete tombs contained all the unclaimed bodies from the disaster. I asked him how many EMTs’ and paramedics’ homes were affected by the flood, and he said, “All of them.” I then asked how many came to work to aid during this tragedy, and he said, “Most of them.”

For my second day, Ken had graciously arranged for me to ride with paramedic T.J. Boudreaux and Alex Sung, MD, in another specialty response vehicle. In New Orleans, doctors like Sung work alongside EMS as support on calls and to provide medical direction if a question arises. I found Dr. Sung to be a valuable mobile resource to the EMS system. Also valuable to NOLA EMS were the rescue unit and Gator vehicle T.J. took me to see. I was amazed to see a rescue unit equipped with extrication equipment that, in my county, only firefighters would use. The Gator is only slightly larger than a golf cart and looks as if it should be used for off-road purposes. It looks aggressive, and I can imagine it being very useful when extricating patients from the narrow, congested streets of the French Quarter. NOLA also has another electric cart for use at busy events at the convention center or Superdome. Patients can be attended to initially on scene, then transported by Gator or cart to ambulances waiting nearby. Working as a team this way to facilitate rapid treatment and transport in some of New Orleans’ unique settings helps ensure the best and most efficient care for each patient.

I felt a strong sense of teamwork as we encountered different crews during the day. My initial thought was that some paramedics might feel intimidated having a doctor on calls for which they were ultimately responsible. What I found was that the crews and the doctor worked as a cohesive team on scene and in the ambulance. The primary focus remained on the patient and how the team could provide the best treatment.

Our last call of the day was for a patient in a v-fib arrest with a return of spontaneous circulation. A citizen who had initiated CPR prior to EMS arrival was relieved by fire personnel once they made contact. We were second on scene behind the FD, and every person assumed a role. They saw the problem at hand and stayed on point. When the ambulance arrived, everything was set up for transport without delay, and the patient was taken Code 3 to the closest emergency department. But the crew’s dedication to the patient didn’t end when they turned over care at the hospital: There I noticed the crew responding to the patient’s wife and her needs as well. This made me remember how important it is to take the time to pay attention to the needs of patients’ families in sensitive situations, rather than moving straight to the paperwork.

Being a spectator behind a camera and not participating as a paramedic was very difficult, but it gave me a chance to view the more human element that’s so easy to miss when working calls. We can get wrapped up in the details and forget that emotionally hurting family members still linger. I was able to interact with the wife of the v-fib patient. She was crying and unable to watch the team working to support her husband of 40-plus years. I felt a deep sadness as she told me they were in New Orleans for vacation, just the two of them, and there was no one close enough to call for support. It seems easier to keep emotional attachments at bay when I put on my uniform. Maybe that’s a coping mechanism developed over the course of my time in EMS, but when I offered her a chair and a hug, I felt just as good as I do when I’m the one getting the pulse back on a cardiac arrest.

I enjoyed my stay in the Big Easy. I ate, drank and walked New Orleans. I was entertained by the life on Bourbon Street, educated by the World War II museum, creeped out by the cemetery in the St. Charles District, nourished with high-quality Creole cuisine all over the city, and deeply humbled by the destruction still visible. After viewing NOLA EMS in action through the lens of my camera, I can truly say their system is top-notch thanks to the people who run it every day. I was privileged to meet them. Let’s not forget that our extended EMS family in New Orleans stills struggles with what most of us take for granted—and from that we can all learn a few lessons.

John Kennedy, NREMT-P, is a paramedic at Paramedics Plus and owner/photographer at Kennedy Photo Creations. See kennedyphotocreations.com.