20 JEMS | OCTOBER 2005

THE BIG PICTUREAmong thousands of apocalyptic images

still surfacing in the wake of HurricaneKatrina, one in particular illustrates the al-truistic EMS response: A lone ambulance,taking a hazardous chance, fords throughfloodwaters toward a stranded community.Ignoring naysaying officials unfamiliar withthe area and its residents, David Hussey, anEMT-B with Acadian Ambulance Service,found a back way into St. Bernard Parish,La. More rescuers followed his lead, bring-ing aid to one of many stricken areaseclipsed by near-anarchy in neighboringNew Orleans.

Even before Katrina slammed into theLouisiana, Mississippi and Alabama coastson Aug. 29, 2005, emergency crews knewdamage from the Category 4 hurricanewould be catastrophic. The below-sea-levelcity of New Orleans was especially vulner-able, doomed by the same, unique geog-raphy that had sustained centuries ofcommerce and culture.

Initial post-storm attention focused onthe ravaged Mississippi and Alabamacoasts, where a 20-foot storm surge wipedout entire coastal communities. Majorhighways disappeared beneath surge-drivensand, and highway bridge decks toppledinto water, eliminating hope of quick mu-tual aid from rescuers eager to assiststricken areas. Responding flight crewsfound few landmarks. The storm had beenso vicious that some barrier islands (and atleast one lighthouse) were swallowed bythe Gulf of Mexico.

Katrina’s wrath continued hundreds ofmiles inland, where tornadoes and straight-line winds shredded trees, peeled the eavesoff buildings and left many communities

without electricity or standard phone serv-ice for weeks.

At first, New Orleans sustained similarwind damage but did not flood. Then aginglevees began to fail.

“They’ve been telling us for years andyears that this [was] going to happen,”says Ken Bouvier, a native of New Orleansand president of the National Associationof EMTs. “We’d dodged the big storms.We’d gotten lucky before, but now ourtime had come.”

Within hours, nearly 80% of the city fa-mous for its Cajun ambience was delugedwith a floodwater roux of sewage, debrisand stagnating chemicals. Decomposing

bodies added to the already biohazardousmess. The heralded French Quarter wasspared major flooding, but the rest of thecity (largely areas that tourists rarely seebut EMS crews know well) was inaccessi-ble to rescuers without boats.

Coast Guard helicopters immediatelybegan hoisting stranded residents, one byone, from the roofs of their swampedhomes. But air rescuers were over-whelmed: Thousands of residents hadlacked the means to leave New Orleansprior to Katrina’s landfall. More than40,000—encouraged by officials—soughtshelter in the New Orleans Superdomeand Ernest N. Morial Convention Center,

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Devastation in Katrina’s WakeAn initial report on the EMS response to one of the worst natural disasters in U.S. history

An Acadian ambulance traverses thefloodwaters of New Orleans.

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believing that the hurricane itself would bethe extent of their nightmare.

After winds died down, restless crowds at-tempting to leave either facility found that thecity was flooding. They were stranded with lit-tle food or water, no working toilets, no powerfor lights or air-conditioning—and an alreadyoverwhelmed public safety contingent.

Promised federal aid did not arrive fordays, leaving rescuers to improvise careunder the worst of circumstances. Horrifyingmedia images remain impossible to forget:outnumbered rescuers triaging angry massesof dehydrated people, bodies of the deadlying and floating across the city, the days-long wait for evacuation, and subsequent de-scent into violence.

Medical and rescue helicopters, rescuers inboats and hundreds of personnel with EMS,fire and law enforcement agencies foundthemselves under gunfire, and rescue opera-tions were temporarily suspended until theNational Guard and U.S. military were clearedto regain control of the city several days afterthe hurricane struck.

But in the midst of post-Katrina finger-pointing, EMS response consistently is draw-ing bipartisan praise. Hundreds of EMSpersonnel continued on the job despite losingtheir own homes in the disaster. Army Gen.Russell Honore, a Louisiana native who mincesno words with either military or media, of-fered compliments to civilian EMS. “We’vegot 300 helicopters and some of the finestEMS workers in the world down there in NewOrleans, and they are making it happen,” Gen.Honore said to a news reporter who had sug-gested apathy within rescuer ranks. “That’sBS,” he added. “I will say that on behalf ofevery first responder down there.”

Ironically, days before Katrina struck,plenty of EMS personnel were in the BigEasy, attending the annual EMS Expo at theconvention center. When Katrina deviatedfrom its initially forecast course and aimedstraight at New Orleans, Expo organizerscancelled Saturday evening activities andurged attendees to evacuate.

Most Expo attendees did leave, but some atthe mercy of airlines were stranded in the city.A few others volunteered to stay and formedtheir own first response groups within thecity’s hotels. Bouvier, a supervisor with NewOrleans EMS, stayed in his hometown, as didNAEMT Past President John Roquemore,who works in neighboring Jefferson Parish.

Thousands of hospitalized patients andnursing home residents were evacuated byground and air from New Orleans prior tohurricane landfall. Dozens of municipal andprivate ambulance agencies descended on thecity and then found the gridlock of groundevacuation prevented quick return trips.

As winds rose with the storm’s approach,calls for evacuation grew more frequent—and frantic.

“The sense of urgency was huge,” says MikeBurney, operations manager of the communi-cations center at Acadian, which transferredby air and ground more than 700 patients inthe 36 hours prior to the storm’s arrival.Evacuations were suspended late Sunday night,when wind-driven debris made the streets toodangerous for ambulance crews.

Even before the storm made landfall, EMSpersonnel outside the targeted area preparedfor the largest mutual aid response in organ-ized EMS history. Service directors through-out the United States were swamped withtheir own flood of personnel who volunteeredto be part of the rescue effort.

Knowing they would need to be completelyself-sufficient in an area left with no electricityor running water, rescuers crammed supplytrailers with everything from oxygen cylindersto sleeping bags, stacks of water bottles, bagsof beef jerky and thousands of pounds of med-ical supplies. Once activated by state offices,hundreds of urban search and rescue crews,

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A military Black Hawk lands to evacuatetriaged patients.

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A victim is evacuated through theuse of a standard kitchen chair.

ambulances, and command and support vehi-cles descended in waves upon staging areas.

One of the largest staging areas was inBaton Rouge, La., where out-of-state EMSproviders filled out paperwork necessary foremergency certification from the LouisianaBureau of EMS office. Many crews assignedto New Orleans lined up their ambulanceson Interstate 10, beneath the CausewayBlvd. South overpass.

Coast Guard helicopters ferried peoplefrom rooftops, and within hours NationalGuard and multiple branches of the U.S.military began arriving in the beleagueredareas, although, controversially, they weren’timmediately deployed to aid those strandedin the city, nor those in outlying Louisiana,Mississippi or Alabama.

Desperation festered among those remain-ing in New Orleans, where reeking floodwaterhad risen to waist level in some city hospitals.Drowning generators fizzled out, cuttingpower to the entire facility and every electricity-dependent item within it. Staff at TulaneUniversity Hospital created their own helipadby knocking over light poles atop an adjacentparking garage so helicopters could land thereand evacuate patients from nearby facilities.

The situation at Charity Hospital becameso desperate that Norman McSwain, MD,chief of trauma surgery at Charity, appealeddirectly to the Associated Press news servicefor assistance. Food, water and power wererunning out, patients were dying, and re-maining medical personnel were at risk fromlooters. They huddled together on upper floors

of the hospital for safety. McSwain e-mailed theAP for assistance in evacuating Charity andUniversity hospitals.

“We have been trying to call the mayor’soffice. We have been trying to call the gov-ernor’s office,” McSwain said in an e-mailobtained by JEMS. “We have tried to useany inside pressure we can. We are turning

22 JEMS | OCTOBER 2005

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Houston fire, EMS and police units werepre-staged well in advance of receivingevacuated Louisiana residents.

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Each rescue workerhas a continuing,unique story. Andmore than a feware shrugging offthe “hero” tag.

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to you. Please help us.”With outnumbered police officers desert-

ing the New Orleans Police Department inrecord numbers, street law ruled NewOrleans for several days. EMS personnelstanding by in the Superdome and conven-tion center soon found themselves endan-gered by roving gangs.

The more time passed, the worse their situ-ation got. Accumulated human waste andtemperatures above 100º F drove thousandsof desperate, dehydrated people outside. Theybrought their dead with them, laid them be-neath sheets and tarps alongside both build-ings, and waited for an evacuation that finallycommenced days after the hurricane.

Once the National Guard and U.S. militarywere finally unleashed on the city’s lawless,hundreds of civilian and military helicoptersorchestrated mass airlifts, releasing some evac-uees to the Causeway triage area and others toanother triage area at the New OrleansInternational Airport, where dozens of C-130aircraft whisked patients away to available fa-cilities across the United States.

Rooftop rescues continued even as OctoberJEMS went to press. Each rescue worker in-volved with the hurricane response has a con-tinuing, unique story. And more than a feware shrugging off the “hero” tag. Manyworked for days without adequate food, wateror sleep, running solely on adrenaline and theongoing need to assist thousands.

Numb survivors are dispersing throughoutthe United States, beginning anew with a mix-

ture of resignation and hope. Following theirinitial rescue from New Orleans, evacueesjoined a complex exodus to nationwide com-munities. Most were relieved to be out of thecity but just as desperate to find their families,who in some cases had been ferried, flown anddriven to other states.

One-quarter of those evacuees—nearly250,000 people—arrived in Texas, 130,000to the Houston area alone. In Houston’sReliant Park, multiple venues (including theAstrodome) swelled with so many refugeesthat the U.S. Postal service created a ZIP codefor the newly dubbed “Reliant City.”

In a massive organizational challenge,Houston area public safety agencies quicklydeveloped response parameters for the tensof thousands arriving in the city. Using an or-ganizational structure tested in 2001 byTropical Storm Allison, Houston area EMS,fire and law enforcement agencies set proto-col for the public safety and emergency med-ical phase of creating a city for 25,000people. Additional thousands were housed inshelters throughout the city.

Many patients who had spent days in theNew Orleans maelstrom were traumatizedand dehydrated. Others who had been with-out needed medication for days were stagger-ing from hypertension, skyrocketing bloodsugar and renal insufficiency, among the manypathologies that were exacerbated.

A partitioned field hospital (complete witha full pharmacy, minor surgery center andmulti-specialty ED) was set up within ReliantCity to handle the influx of people. Evacueesneeding hospitalization were transported byambulance to Houston area hospitals, whichdespite a chronically high census still maderoom for the city’s new population.

With its own future uncertain, New Orleansnonetheless is beginning its recovery.

At press time, New Orleans EMS, whichruns emergency calls within the city, is trans-porting its trauma patients straight to theMississippi River, where the medical shipUSS Iwo Jima is docked where cruise shipsonce were moored.

“There are still a lot of people who don’twant to evacuate,” Bouvier said. Althoughmuch of the city’s populace has left, those re-maining (plus those who are in the city to cleanup) still need ambulance coverage, so NewOrleans EMS has set up temporary shop in anursing home building that wasn’t flooded.

“It’s brought us closer together because

we’re all kind of camped out together,”Bouvier said. “Some of our (former) em-ployees who moved away have come back tohelp us. They saved their old uniforms andcame back.”

The topography of every service area haschanged. Familiar landmarks and even streetsigns are gone. Sometimes, crews “can’t getthere from here” and must be creative toreach their patients. Many services through-out the affected states have accepted out-of-state assistance from other agencies thathave shared their ambulances, equipmentand personnel.

Because snipers targeted New Orleans res-cue crews during the darkest days after thehurricane, EMS personnel there now respondwith long-rifle protection from U.S. Customsofficers. They fuel their ambulances directlyfrom tanker trucks. Radio communication hasimproved, but cell phones are dicey, depend-ing on the carrier and area code. All emer-gency responders working in or around NewOrleans have been inoculated against tetanus,and hepatitis A and B.

Despite the blow dealt to the Gulf Coastand New Orleans, service directors and su-pervisors remain optimistic and proud of theabove-and-beyond performance of EMS per-sonnel during the continuing crisis.

“Some of our employees are continuing towork even though they’ve lost their homes,”says Julie Mahfouz, public information officerfor Acadian. “They’ve lost everything but theyhaven’t stopped working.”

Numerous relief funds have been set up toassist EMS personnel who have lost or sus-

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For several days, street law ruled New Orleans.

Rescuers were fueled by a need to help.

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tained serious damage to their homes in thewake of Hurricane Katrina:

The NAEMT has an extensive database ofEMS-related relief funds, temporary housingand opportunities for volunteering withinthe damaged area, posted on its Web site atwww.naemt.org. The site receives continuousupdates and includes links to its EMS Rescuerand Relief Fund, which was initially estab-lished after 9/11 but remains operational.

Acadian Ambulance Service, which pro-vides emergency coverage to the entire stateof Louisiana, part of Mississippi and non-emergency service to Baton Rouge and NewOrleans, has established a relief fund for per-sonnel whose homes were lost to HurricaneKatrina. More information is available onlineat www.cfacadiana.org, or contact RaymondHerbert at 337/266-2145.

—Courtney McCain

FLYING INTOTHE STORMAs the air ambulance pilot banked the

chopper and slowed his descent towardthe Superdome, he asked again, “Are you sureyou want to do this?”

The pilot, my editors and my family all hadissues with my plan to wade into New Orleanswithout a way to get out. Thugs were shoot-ing after dark, and I didn’t have any ideawhere I was going. I was on my own.

“Positive,” I said, trying to hide my ownfear. This, I had to see.

I wanted to find what was left of NewOrleans EMS, a group I’d met while investi-gating EMS in the nation’s 50 largest cities. Iwanted to see first-hand how they handled ahistoric crisis.

I had dropped into mass casualty eventsrepeatedly since becoming a USA TODAY re-porter in 1992. Plane and train crashes, shoot-ing rampages, hurricanes like Andrew, andterrorist attacks on Oklahoma City and 9/11were among the massive, national tragediesI’d covered.

As a former paramedic, I’m always curiousto see how EMS responds to these unfore-seen challenges when I reach the scene of aBig One.

The Superdome was emptying fast when Iarrived on Friday morning, four days afterKatrina roared through. But few people acrossthe nation knew the downtown conventioncenter still had about 20,000 people baking,without food or water by day, and being vic-

timized by whacko vermin each night.I first rolled down Convention Center Blvd.

in front of the Ernest N. Morial ConventionCenter midday Friday with police officers asthey moved into the area in force for the firsttime. They had refused to go in until they hadscores of SWAT officers. The area was stillconsidered by typical measures too dangerous,but the military was on its way, bringing foodand water.

But, by modern American rules, cops—notsoldiers—had to go in first.

As I rode in the back seat of a command car,the police chiefs looked nervous. It was as ifthe first arriving cops in bulletproof vests andcarrying assault rifles were walking across alake covered by a thin layer of ice.

When they stopped just a few feet from acorpse covered by a blanket in the median, po-lice explained to angry residents that militarytrucks with food and water were rolling in be-hind them. They listened as people told ofmurders, more bodies inside the conventioncenter and sick people dying.

As we left the area, it was clear that the peo-ple posed little threat. They just wantedhelp—desperately.

A few miles away, the city’s EMS crews were

itching to help them. They knew that somevery sick people had gone four days withoutinsulin, dialysis and life-sustaining medicines.They knew people had already died. And theyknew more would likely die overnight. Butwith just a few ambulances and no workinghospitals in the city, the traditional method—assess, treat and transport—was not an option.

New Orleans EMS needed massive re-sources to rescue these people. But withoutgood communication with the outside world,they had trouble getting the resources theyneeded. Then the military arrived.

When choppers from every branch of thearmed forces started landing in the conven-tion center parking lot on Saturday, the city’sEMS was back. Finally, they could get theirneighbors to hospitals.

And the way the city, and in particular NewOrleans EMS, treated its residents remindedme of what EMS is really all about. Assessingand evacuating 20,000 people in eight hoursrequired grit. The desire to help, combined

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By Wednesday, Aug. 31, a disaster med-ical assistance team from New Mexicohad arrived at the Superdome to assist incare and evacuation.

continued on page 66

with an instinct to act, drives EMS.Police stayed away. The military deployed troops elsewhere.

Yet the 80 staffers who remained in the battered New OrleansEMS could not be stopped from going into the mob looking forthose who could still be saved.

The crews marched in to help the sickest people I’d everseen—miles and miles and miles of them. All kinds of organ fail-ure. All kinds of suffering.

It was triage by attitude. If people were healthy enough toargue about why they should go first, then they weren’t sickenough—yet. We loaded enough critically ill people to fill sev-eral hospital ICUs onto anything we could find with wheels androlled them to the parking lot for rapid air evacuation.

Every few steps, medics took to a knee, held a hand, toucheda shoulder, rubbed a back and even cleaned feces from one eld-erly woman lying, for the fourth consecutive day, on the hot,stinky sidewalk.

By dusk, the job was done. The place was nearly empty.Thousands of people were finally at hospitals getting qualitymedical care.

In the end, it was New Orleans EMS that moved people for-gotten by the nation.

The brilliance within the Star of Life, in a way I had never seenbefore, is simple, deep-rooted and unending compassion.

At its most basic level, EMS is simply people caring for peo-ple on the street in a time of unimaginable need. As a medic, Iused to wonder what The Big One would be like. Turns out it’swhat EMS takes on every day. —Robert Davis

STRANDED PROVIDERS PITCH IN TO HELPBill Brown, RN, executive director of the National Registry

of EMTs, who was in New Orleans for EMS Expo, decidedto stay behind to help the sick and injured. He contactedAcadian Ambulance Service, which provides EMS coverage formuch of Louisiana, and was rapidly assigned to assist at the med-ical aid station established at the Superdome.

By 9 a.m. Sunday, Aug. 28, Brown says chaos had taken overthe loading dock area where the special needs patients/evacueeswere being processed. “Throughout the day,” says Brown, “theSuperdome had received oxygen-dependent patients. Many toldme they came to the dome because that’s where they were in-structed to go after calling the hurricane hotline.

“Unfortunately, a football stadium does not have oxygensupplies. Many of these misinformed patients needed a con-tinuous supply of oxygen, and when I told them no oxygenwas available at the dome many of them had a stare of panicin their faces. Toward 7 p.m., the New Orleans HealthDepartment made arrangements with Tulane UniversityHospital to accept over 40 oxygen-dependent patients. SinceAcadian was the only ambulance service with drivers andmoving trucks in the area, the health department comman-deered the ambulances. ... It took until past 10 p.m. onSunday night to identify the patients who were going toTulane Hospital, get them loaded onto ambulances or wheel-

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chair vans and get them transported away from theSuperdome. We had evacuated all oxygen-dependent patientsso none would die in the Superdome.”

Another stranded paramedic, Stephanie Korzyk, also con-nected with Acadian and helped at the Superdome aid station.“At one time I was threatened by a man who said he was goingto stick me with a needle,” she says. “He wanted out.”

She describes another patient encounter: “This one veryyoung woman came in having an acute asthma attack, whichwe treated with the usual medications. We had to start venti-lating her and almost had to intubate her, which would havebeen really bad since we had no vents and couldn’t just sendher out on an ambulance. After treating her, we sent her up-stairs to the special needs area. She came back down.

“She repeated this process three times. She was in status asth-maticus. A doctor who happened to come in said that after wetreated her this time we were to have her sit in the hall, and—whatever happened—we were not to continue to treat her. Wecould not waste all our resources on one person. He said thisplainly, clearly and loudly right in front of the patient.

“She started to cry and said, ‘I don’t want to die.’ I thinksomeone brought her to an area where they were transportingsome patients to a hospital by that time. I don’t know what hap-pened to her. It was a true MCI.”

Paramedic Valarie Ziminsky was stranded after her flight homewas cancelled. She decided to help and hooked up with NewOrleans EMS. After EMS and fire activities were suspended dueto the high winds on Sunday night, she and approximately 40other EMS providers took shelter in the Louisiana StateUniversity Dental Clinic. On Monday, after the storm passed, shesays, “We began talking about getting out of the building andquickly realized we were going to need rescuing ourselves.”

On Tuesday, the group finally escaped the clinic and foundthemselves an on overpass. “I was immediately drawn into assist-ing with patient care—chest pain with nitro, an unconscious fe-male, an asthmatic, a man possibly suffering a massive stroke, a36-week pregnant dehydrated mother,” says Ziminsky. “My firstconcern was medical command, but what medical command?There was no one to call. People were looking for me and theothers to help them to the best of our ability, and so we did. Theworst cases were prioritized, and as the Black Hawks came in,three patients went out on each helicopter along with a medic. Istill don’t know where they went. As far as I knew, based on lim-ited radio communication, most of the city hospitals were closeddue to flooding and power failures. ...

“You could see it in the faces of nearly every single person—EMTs, medics, police, the citizens on the bridge—stunned dis-belief. And they were all pretty much in the same boat. They hadlost their homes, cars, clothing, everything they owned. AsEMTs and paramedics, we are trained to help and find a way tomake everything work. But in this case, it was a powerless feel-ing. What do you do when everything is flooded, there is mini-mal road transportation, hospitals are closed?”

Many EMS providers have shared their experiences withJEMS. Above, we provide just a taste of their stories. Stay tunedfor the November issue, which will contain extended coverageof these and many other exclusive reports. JEMS

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