Major Incidents

EMS Response on the Mississippi Coast

Issue 11 and Volume 30.

New Orleans may have received the most media coverage following Hurricane Katrina, but the storm also devastated the Mississippi Gulf Coast. This article presents an initial look at the EMS response to Hurricane Katrina in Mississippi. It is not intended to be an all-encompassing perspective on EMS in the state.


The Incident Command System

The Mississippi Department of Health, Bureau of Emergency Medical Services (BEMS) activated its contracted ambulance agreements on Saturday, Aug. 27, dispatching the EMS Mobile Command Center and a total of 23 state ambulances to aid in evacuating hospitals, nursing homes and other long-term care facilities. The EMS Mobile Command Center is responsible for all credentialing of emergency medical responders to the disaster. Additionally, it’s responsible for forward communication and serves as the central point of communication for the State Emergency Management EOC and the Mississippi Department of Health Command Center.

All of Mississippi’s contracted ambulances were repositioned prior to Katrina’s landfall to ensure the safety of each crew.

After landfall, many counties experienced a surge in call volumes and required additional EMS resources to meet the needs of the local jurisdictions. Also, additional evacuations of hospitals and nursing homes were needed. At its peak, BEMS had coordinated and dispatched 83 ambulances to assist in recovery efforts in more than 15 counties in the southern part of the state. Offers for mutual aid from additional in-state and out-of-state ambulance services started coming in just after landfall.

According to Steve Delahousey, vice president for the Gulfport-based South Central Division of American Medical Response (AMR), AAA Ambulance Service CEO and retired director (1974–2000) of the Miss. State Department of Health Division of Emergency Medical Services, and Wade N. Spruill Jr., EMS in Mississippi functioned quite well under the Incident Command System. “The National Incident Management System was utilized, [making it possible for] entire states, such as Florida, with a wealth of experience in hurricane mitigation [to] essentially became part of the Mississippi command team,” says Delahousey.


Advance Preparation

While Katrina was still brewing offshore, AMR—the busiest ambulance service in Mississippi—made substantial preparations, says Delahousey. AMR, which serves Adams, Hinds, Madison, Rankin and the coastal counties of Harrison and Hancock, transports about one of every four ambulance patients in the state. The company was responsible for coordinating medical resources through the Harrison County EOC.

AMR set up an off-site national coordination center to manage deployment of its ambulances from other operations (e.g., those in nearby Texas and Florida) and to coordinate efforts with federal, state, and local authorities. The company also identified a plan for dealing with special needs patients. It included evacuation of all the area’s nursing homes and assisted living facilities.

Once Katrina made landfall, prehospital providers faced numerous challenges that required them to display leadership and courage. Katrina caused a significant breakdown in communications. The only system of communication that was available to EMS and hospitals was the satellite-based communication system established by the Department of Health. However, many services dispatched to the affected areas did not have this capability. Although EMS is used to working independently under medical control, it becomes an altogether different matter when you have no communications with dispatch, medical control or the outside world. EMS rose to the challenge and relied on their training to do the best job they could.

Roles changed for many paramedics and EMTs operating independently. By default, AMR employees became the sole providers of health care in many areas. EMS was granted exemption of protocols and played a primary health-care role in some circumstances, assisting the Department of Health in disseminating information and administering the tetanus toxoid adsorbed vaccine.

ALS ambulances were not tied up for transport of non-critical patients. Patients who were “green” (i.e., the walking wounded) were transported by whatever means was available—in police cars, fire trucks and other vehicles.

Throughout this response no patients were lost, and one must reflect on the sentiments of a young New York paramedic working at the disaster site in Biloxi who was overhead talking on his cell phone saying, “I’ve never been so proud to be working in this profession as I am now.”


Non-Traditional Roles

Another ambulance service that provided outstanding leadership and direction was AAA Ambulance Service, based in Hattiesburg, Miss. AAA serves the counties of Forest, Perry, Walthall, Perry, Jeff Davis, Lamar and Marion, and Spruill has had experience in mitigating a number of hurricanes during his career.

AAA provided invaluable assistance to its citizens, in both traditional EMS roles and non-traditional ways. Example: Forrest General, the largest hospital in the Hattiesburg area, required evacuation. Operating under a unified command at Forest General, AAA contributed to the coordinated evacuation effort, making it a seamless and highly effective operation.

Several counties, such as Stone, Marion and Walthall, were completely on their own in terms of EMS response for a time. Because all communications were lost, district supervisors took charge, functioned independently of medical control and dispatch and just did the best job they could.

Other EMS agencies, such as Baptist Golden Triangle, Webster Health Services, North Miss. Medical Center EMS, Oktibbeha County Hospital EMS, Metro Ambulance Service, Rural/Metro, Magnolia Health Center EMS, Tippah County EMS and Orange County Florida Fire and EMS (in Stone County), augmented the response.

“Communications by far were one of our biggest challenges,” says Chuck Carter, Forest General-based Rescue 7 director of quality assurance and flight services. “Primary communications reverted to the 40-year-old high-band, statewide hospital net.” This was used extensively throughout the disaster by hospitals to coordinate patient transfers and for hospital administrators to speak with their counterparts throughout the state.

Adding to provider frustrations was the inability to respond to calls due to debris and blocked access. In these circumstances, dispatch worked extremely hard to console patients and their families by providing the best care they could over the phone.

Another challenge EMS continues to face in the Hattiesburg area is the surge in population, especially at nearby Camp Shelby, one of the military’s main forward operating bases in the affected region. Camp Shelby is expecting 4,000 troops from Tennessee along with 6,000 family members by Nov. 1, 2005.


Air Ambulance Service

Although grounded during the storm, aeromedical evacuations in Mississippi played an important role in ensuring the survival of patients in the affected areas. “We went out of service Sunday night, Aug. 28, having to hanger the aircraft due to the impending hurricane,” says Donna Norris, program director and chief flight nurse for the University of Mississippi Medical Center’s AirCare, based in Jackson, “and were down all day on the 29th. We began two-
patient evacuations from the Gulf Coast on the 30th.”

“Prior to the hurricane,” says Carter, “Rescue 7’s helicopter was near its 100-hour maintenance limit. The FAA granted a 10% extension, but eventually it had to go out of service.” Rescue 7 does not have a back-up aircraft, but a number of flight teams, including those from Hospital Wing, AirCare, Air Evac Lifeteam, Vanderbilt LifeFlight and military services, assisted in the evacuation efforts. Once Rescue 7 was placed out of service, it continued with the coordination of rotary wing assets.

Significant safety hazards existed at landing zones. Most cell towers lost their red flashing collision-avoidance beacons. Communications between aircraft and receiving facilities, ground crews and medical control were impossible. Satellite phones weren’t initially available. Despite the initial shock and the unexpected amount of devastation affecting crews and pilots, flights continued unabated, with all missions being conducted safely. This is an important testament to the professionalism of all flight programs operating in Mississippi during this time.


Lessons Learned

Within the first few weeks post hurricane Katrina, a number of concrete lessons have been learned. None can be more important than the need for accurate planning and exercising of disaster drills.

As described, communications were nearly impossible following the storm. Unfortunately, the vast majority of Incident Command courses don’t accurately simulate the total loss of communications or address the use of the Radio Amateur Civil Emergency Service. RACES is an underutilized asset and perhaps the best means of civilian emergency communications available and readily deployed in times of disaster.

Maintaining a fleet of ambulances with the addition of mutual aid resources requires ingenious ways of ensuring fuel supplies are available. Fortunately, throughout the disaster, FEMA organized supplies of jet fuel for air ambulance use.

In short, despite communication problems, the National Incident Management System worked essentially as planned in Mississippi, enabling the EMS response to be one that prehospital personnel the world over should be proud of.