Flood Response: EMS on the Front Lines in Kentucky

According to the latest figures from CNN, at least 37 people died in last week’s flooding that left parts of Eastern Kentucky under record water levels. Accounting for all missing persons could take weeks, according to Kentucky Gov. Andy Beshear.

Beshear called the disaster “one of the most devastating deadly floods that we have seen in our history.”

“I’ve been in emergency management for most of my career, and this disaster is among the worst I’ve seen,” says David Fifer, a paramedic and coordinator of RedSTAR, Powell County Ambulance Service’s volunteer wilderness EMS team, an elite special-ops unit that covers Kentucky’s Red River Gorge.

The number of people rescued from the flood measures in the thousands, Fifer said, putting it on the level of 2017’s Hurricane Harvey.

Current Operations

At present Fifer and his team have shifted from active flood response to a recovery and support role. During active operations Fifer’s main role was hoist rescue aboard a Huey helicopter based in Hazard, Kentucky, alongside Kentucky state troopers. His team completed 8 hoist rescues in addition to land-based evacuations and support missions.

Joe Holley, MD, FACEP, FAEMS, is medical director of Memphis (Tenn.) Fire Department as well as EMS medical director for the state of Tennessee and USAR Tennessee Task Force-1, along with serving as active member of FEMA’s Incident Support Team, which was activated to respond to the Kentucky floods. At the height of the flooding, creeks rose over their banks by 20 feet, carrying away entire houses downstream, Holley reported during a recent meeting of the Gathering of Eagles group of metropolitan EMS medical directors.

Deep quicksand-like mud, debris piles, deep ravines, washed-out roads, crumbling bridges, and treacherous infrastructure are only a few of the severe challenges federal and local crews continue to face, said Holley, whose team is still in the process of active search activity but transitioning to a recovery mode. Communications can be spotty, power lines remain down, household chemicals leak, and support services are often hampered by the poverty of the area.

CNN reported that 30–40 bridges in the county were washed out or inaccessible. Temperatures in eastern Kentucky for the rest of the week are forecast to be in the mid 80s with a chance of more storms.

Beshear said in a Tuesday press conference that 8 cooling centers will open in eastern Kentucky. “Don't be too proud to go to one of these places,” he said. “It's going to be really hot and really dangerous.”

Clinical Care

Holley and Fifer shared with EMS World that medical care in an active flood zone spans a wide spectrum of illness and injury.

“It’s pretty broad here,” Holley said—skin abrasions, heat-related emergencies, trauma and exacerbation of underlying medical issues are persistent clinical needs. Fifer’s team executed an evacuation of a line of a dozen trapped cars that included patients with altered mental status and diabetes. One was in hospice care. Fifer's crew rescued a man who had tumbled into the flood water. Another who was trapped in his house and having a stroke had to be rescued via the landed aircraft.

Every county in Kentucky has an emergency management director, Fifer explained. The federal response served a support role for local systems and worked side-by-side with local EMS teams, supplying manpower, infrastructure, and equipment. Kentucky National Guard units were activated for evacuations, delivery of supplies, search and rescue, and support.

Treating responders to the scene often surpasses that of area residents, Holley pointed out. Musculoskeletal injuries arise from the intense nature of search and rescue work. Wet, muddy conditions lead to environmental injuries like stepping on nails and broken boards. Sunburn, insect bites, and dehydration are common.

Proper PPE and decon practices are critical in a high-moisture environment, stressed Holley, whose team also works to assess medical capabilities and resources and sets up arrangements as needs evolve.

Pets and Wildlife

Holley encountered a “surprising number of domestic animals” in the flooded areas, along with displaced wildlife—his crews have experienced multiple encounters with rattlesnakes, copperheads, and cottonmouths who were “not happy to be washed out of their homes.” Insects are incessant pests while traversing underbrush. He’s seen ant mounds floating down rivers and bears walking nearby. Holley carries snakebite antivenom kits and made arrangements with veterinarians in the area to treat injured animals.

“I’ve been in emergency management for most of my career, and there’s never a plan for the pets,” Fifer says, adding that many rescue shelters don’t allow animals, but evacuees often refuse to leave their pets behind, which can pose quandaries and delay operations.

In addition to an assistant professor post at Eastern Kentucky University, where he directs the university’s Center for Wilderness & Outdoor Public Safety, Fifer serves as an emergency management specialist-incident management team operations officer for the US Administration for Strategic Preparedness and Response (ASPR). He has completed a laundry list of certifications and trainings related to disaster rescue—technical rope rescue, radiological response, multihazard and hazmat, wilderness medicine, search and rescue and more.

Accommodations

Response crews from outside the area have been put up in school gyms and similar facilities but often sleep in their vehicles or makeshift temporary quarters, said Holley.

“We are still focused on meeting the immediate needs of providing food, water, and shelter for thousands of our fellow Kentuckians who have been displaced by this catastrophic flood,” Beshear said July 31. “At the same time we have started on the long road to eventual recovery.”

COVID is an ongoing concern, said Holley. Rescuers are often confined to close quarters and masking is critical—though often an extreme challenge while performing exhausting work in hot and humid conditions.

“We are still on top of each other,” said Holley. “Nothing like managing a pandemic when you are sleeping in the back of a truck.”