Major Incidents, Operations

Air Ambulance Crews Evacuate Hundreds

Issue 11 and Volume 30.

Air medical teams from across the United States played a key role in rescuing trapped residents and evacuating patients stranded in New Orleans hospitals and at the Superdome following severe flooding from Hurri­cane Katrina. Companies involved in flying hundreds of ailing residents to safety included Louisiana’s Acadian Air Med Services, Air Evac Lifeteam, Air Logistics, LifeAir, Bell Helicopters, Miami Life, PHI Air Medical Group’s Air Evac Services and others.

Louisiana EMS provider Acadian Ambulance initiated and organized a major air operation when flooding made it clear that flights would be the only link to survival for many critical patients, cut off from rescue with generator-driven electricity for ventilators and other machines soon to run out. “Companies with extra aircraft responded to the call for assistance, and we flew nonstop daytime missions from Tuesday through Friday following the storm,” says Erroll Babineaux, vice president of Acadian Air Med Services. “Our own seven helicopters likely flew 300 hours during the evacuation, and we were still doing scene calls throughout our response area.”

Air med units flew out an estimated 700 patients during the days immediately after Katrina.

Babineaux has experienced plenty during his 30 years in EMS with Acadian, but Katrina will be memorable for its myriad challenges, particularly the evacuation of the major hospitals in New Orleans. “There were eventually 27 civilian EMS helicopters involved in evacuating Tulane Medical Center, Charity Hospital and others,” says Babineaux. “The aircraft flew every type of patient, from NICU to surgical, oncology and geriatric, during those four days.

“Tulane’s parking garage served as the landing zone; hospital staff pushed patients up the seven or eight floors to the roof, where the light poles had been removed. Once the aircraft finished with Tulane’s patients, we started on Charity Hospital, next door. Charity staffers carried their patients through the floodwaters, into the parking garage.”

To reduce flight times, helicopters flew patients to a staging area on Interstate 10 at the Causeway where ground ambulances took over transport. “The number of patients evacuated in that time frame would not have occurred without the great involvement of all these air medical groups,” continues Babineaux. “Clearly, countless patients’ outcomes were improved thanks to the air operation.”

According to Missouri-based Air Evac Lifeteam spokesperson Julie Heavrin, hospital-operator HCA requested the company’s assistance in flying patients from water-logged Tulane Medical Center. “Our crews eventually flew patients from New Orleans facilities, as well as locations in Gulfport and Biloxi, Miss., where we evacuated 57 patients,” says Heavrin. “Our operations handled a total of 100 patients, varying from pediatric to dialysis cases, in these hurricane areas.”

 

Overcoming Communication Challenges

Responders faced large-scale disruption to the usual means of EMS communication immediately following the storm. Towers for both traditional radio repeaters and cellular phones fell to the winds, and flood waters impeded repair access. “We were up and running with satellite telephones in the wake of the storm,” says Babineaux. “And Iberia Parrish Sheriff Sid Hebert was a real lifesaver. He had the Sheriff Department’s Mobile Command Center brought in to assist with radio communications.”

A military Airborne Warning and Control System (AWACS) jet arrived over the city to assist aviation operations, according to Babineaux. “The AWACS handled all civilian and military air traffic; each helicopter had its own transponder code and waited for clearance from the military controllers to enter the New Orleans airspace.”

According to Heavrin, a satellite-based communication system using PDAs (personal data assistants) proved its worth. “We had been trying this newer system prior [to the hurricane], and it paid off during the response,” she says. “In fact, we accomplished 90% of our communications by text messaging. Each aircraft received assignment instructions and other information from our operations center in West Plains in this manner.”

Crews also used satellite telephones, and a special hurricane operations center, staffed by members of management at the company’s West Plains, Mo., headquarters, monitored aircraft locations via satellite flight following. “Our aircraft operate with automated flight following equipment from SkyTrac Systems, which allowed our staff in West Plains real time flight tracking and location data via the Internet,” says Heavrin. “And SkyTrac sent a technician to assist with on-site support, which was a real help in this busy operation.”

Acadian Air’s fixed-wing aircraft also played significant roles, evacuating critical care patients from the Belle Chase Naval Air Station in New Orleans to distant hospitals, according to Babineaux. “Every return flight, the planes brought doctors, nurses and medical supplies back into the hurricane damaged areas to assist. The fixed-wing fleet continues to see heavy flight hours bringing folks back now as the city recovers.”

 

The Mississippi Experience

Flight paramedic/nurse Jon Blakely shared his experience as he responded with his helicopter medical team to assist in the evacuation of hospitals in Gulfport, Miss. Normally staffing one of Air Evac Lifeteam’s satellite bases in Cullman, Ala., Blakely and crew arrived in the area to find utter devastation. “You can see the news footage, but not until you fly over these scenes does the real scope become apparent. It looked like the whole 10 to 12 blocks of the Mississippi coast from the water inland [was] gone,” he recalls. “I saw a Waffle House sign and no Waffle House building, same with an O’Charlies. Piles of debris and no homes anywhere to be seen.

“Our job was to assist in evacuating patients to Mobile, Ala., from hospitals like Gulfport Memorial. We arrived to find that all the windows on the Gulf side of that hospital were blown out. Like many facilities, they needed to get patients out because their generators would eventually run out of fuel to provide electricity, meaning ventilator and other critical care units faced a major problem,” continues Blakely.

“So we had even more compassion for all these patients because not only were they in poor health, there was simply nothing left of their homes, communities and area, nothing for them to go back to once we flew them out. We handled diabetics who had run out of meds, peds and the whole range seen in a hospital.”

He admires all the hospital staff who had been “up for days, doing great work in miserable conditions.” Constants were a lack of electricity, drinking water and sanitation.

Communications again proved the greatest challenge in Mississippi, like other regions in Katrina’s wake. “There were no links for these hospitals initially; frequently, they did not know help was flying in. And we had to do all our position reports, patient updates and status via our satellite text messaging service; no voice communication via radio or cell phone.” Satellite phones eventually made it into the hands of EMS and hospital personnel.

Initial efforts at air evacuations proved challenging due to the lack of communications; delays of one to two hours occurred as facilities prepared patients for transport. Blakely says their flights averaged 30–35 minutes one way, and once the operation began, efficiency increased, allowing his team to fly five patients on some days.

Risk mitigation decisions were readily apparent in local air operations as well. “With no electricity in this region, we decided to suspend any nighttime flight operations,” says Blakely. “It was pitch black, with no reference points, and our pilots were unfamiliar with the area, so we shut our ops down at night. We want to do everything we can to help people, but have to be able to come back to our families at the end of the mission.”

Providers nationwide participate in disaster drills but no matter how many drills, Blakely feels responders always need to be ready to adapt. “It was an unbelievable experience. From the shock in seeing such devastation to adapting to no voice communications during our flight operations, we had to be ready for whatever developed.”

“I think everyone has learned something from this response,” says Blakely, who feels that having a cache of satellite phones needs to be a part of all agencies pre-planning efforts in the future.

 

Superdome Air Evacuation

Providers working the Superdome faced treatment and transport challenges as well as threats to their safety. David LaCombe, Director of Acadian’s National EMS Academy, responded to the Superdome on Tuesday morning immediately following the storm and found himself heavily involved in scene EMS as well as air operations. “We flew in to relieve personnel who had been there through the storm. Our people started work from the state’s command post in the Superdome and established an aid station for triage and treatment.”

“At the same time as we arrived, the levees were breaking, creating a disaster within a disaster, which had not been planned for at the Superdome. Initially, there were 20,000 people in the stadium but as the waters flooded the city, that number quickly doubled.”

“It became quickly apparent that we would need air resources for not only the heat and medical patients we were seeing, but also the ven­tilator and other types of patients
arriving from nearby hospitals,” continues LaCombe. Via satellite telephones, LaCombe contacted Acadian’s communications center in Lafayette for assistance. “That Tuesday evening, military helicopters arrived, landing at the municipal heliport next door. I flew with two of the ventilator patients to Louisiana State University (LSU) Medical Center in Baton Rouge.”

As conditions worsened, with no running water or electricity at the Superdome, tempers flared among residents who remained, with some threatening the very people assigned to help them. At one point, National Guardsmen told LaCombe and other EMS personnel they could no longer defend their aid station, so responders consolidated operations with two Disaster Medical Assistance Teams (DMAT) that were operating a critical care/intensive care unit aid station in an adjacent building. “It was frustrating, because when we tried to provide care out among the crowd, we were not safe.”

With countless people now trapped by rising floodwaters, military helicopters were diverted to search and rescue operations, leaving private providers to bear the majority of further flights. “By Wednesday afternoon, the air operation was in full swing, landing the smaller helicopters on the parking garage roof next door,” recalls LaCombe. “We placed patients in a staging area so they could be quickly loaded onto the aircraft, one critical and one ‘walking wounded’ to maximize efficiency of each flight. A coordinator remained at the LZ handling the aircraft and loading operations.”

Safety was a paramount concern given the large number of helicopters operating in the tight downtown airspace. “I think everyone had a heightened awareness level during the air operation because of its complexity, which further helped move events safely,” says LaCombe.

Lessons learned from the air operation include the need for a takeoff and landing coordinator, hand signal standardization and training, as well as noise-reducing headsets. Helicopter support kits placed around the state and available for this type of operation would also be a benefit.

“Overall, our leadership back at Lafayette really listened to us on scene and made things happen,” says LaCombe. “A lot of this came through thanks to the sheer tenacity of our CEO and others working very hard to bring the resources to us down in the stricken areas.

“With Mardi Gras, we have months and years to prepare, and you know where it will take place. But here, the infrastructure is gone, landmarks [are] washed away and your own providers have the stress of having lost their homes. [Katrina destroyed the residences of approximately 50 Acadian employees and families.] No other response I have been involved with compares to Katrina.”

 

Mission Accomplished

Babineaux recognized the efforts of everyone involved in the EMS response to the disaster. “Bottom line: In a disaster situation, you have to be able to take care of yourself and local area for a period of time. We all pulled together, and I can’t say enough about the hard work by all the providers and air medical companies during this challenging response.”