Major Incidents

The Chaos of Katrina

Issue 11 and Volume 30.

As Hurricane Katrina approached landfall on Saturday, Aug. 27, President Bush made an emergency disaster declaration for the parishes around New Orleans. Michael D. Brown, then-Under Secretary of Homeland Security for Emergency Preparedness and Response, announced that FEMA would “mobilize equipment and resources necessary to protect public health and safety by assisting law enforcement with evacuations, establishing shelters, supporting emergency medical needs, meeting immediate lifesaving and life-sustaining human needs and protecting property, in addition to other emergency protective measures.”

New Orleans residents were being urged to evacuate the city. City officials expressed fear that 80% of the city could be flooded. A major EMS conference being held at the convention center was in its final day, but attendees and exhibitors weren’t told to leave the city early, leaving many stranded.

On Aug. 28, the New Orleans Superdome, a designated emergency shelter, opened its doors at daybreak.

As the storm grew, President Bush declared statewide emergencies for Louisiana and Mississippi.

FEMA began moving supplies of generators, water, ice and food into the region for immediate deployment once the storm passed. It also mo­bilized USAR teams, designating Shreveport, La., to serve as a staging area for teams from Tennessee, Missouri and Texas. USAR teams from Indiana and Ohio waited for orders in Meridian, Miss. Two teams each from Florida and Virginia and a team from Maryland remained on alert at their home stations.

Nine full Disaster Medical Assis­tance Teams (DMATs), each with 35 members, and nine strike teams, each with five members, were deployed to staging areas in Houston, Anniston, Ala., and Memphis, Miss.

At 7 a.m. (EDT) on Aug. 29, the National Hurricane Center issued a hurricane warning effective for the North Central Gulf Coast from Morgan City, La., eastward to the Alabama/Florida border, stating, “Preparations to protect life and property should have been completed. … Maximum sustained winds are near 145 mph … with higher gusts. Katrina is a strong category four hurricane on the Saffir-Simpson scale. Some fluctuations in strength are likely prior to landfall … but Katrina is expected to make landfall as a category four hurricane.”

A National Oceanic and Atmospheric Administration (NOAA) hurricane specialist says New Orleans suffered sustained winds of approximately 90–92 mph. A lakefront station at Lake Pontchartrain reported wind gusts of 114 mph.

In the storm’s initial aftermath on Aug. 29, the media focused its attention on the Mississippi and Alabama coasts, where a 20-foot storm surge had wiped out entire coastal communities. Major highways had disappeared beneath water, sand and debris, eliminating hope of quick emergency aid. Then the levees that protected New Orleans from flooding began to fail. Within hours, the city was almost entirely under water.

On Sept. 2, Brown called for patience, describing Katrina as “a disaster of catastrophic magnitude.” FEMA had deployed nine USAR teams, a National Emergency Response Team to Louisiana, and four Advance Emergency Response Teams to locations in Mississippi, Alabama and Florida. Thirty-one National Disaster Medical System (NDMS) teams, including 23 DMATs, were deployed to staging areas in Anniston, Ala., Memphis, Tenn., Houston, Dallas and New Orleans. Two Veterinary Medical Assistance Teams (VMAT) were also part of NDMS assets.

Also on Sept. 2, a thousand National Guardsmen were dispatched to the New Orleans Con­vention Center to help evacuate thousands of people who had been without food and water for up to five days. And on Sept. 3, President Bush ordered more than 7,000 active duty forces to the Gulf Coast.

Not until Sept. 4—six days after Katrina made landfall—were 100% of the evacuees stranded in the New Orleans Superdome and convention center evacuated.

Unfortunately, help did not reach the people most in need soon enough. In October, the Associated Press reported that the search for Hurricane Katrina victims had ended in Louisiana with a death toll of 964. In Mississippi, the toll was 221.

Although it’s still too soon to attempt a full analysis, some lessons are already apparent. Bill Brown, RN, executive director of the National Registry of EMTs, volunteered to assist at the medical aid station established at the Superdome, and he offers the following lessons: “[T]here was no incident command system in place. This was a major mistake. … Although police and fire are necessary at most disasters, I found the need for medical personnel to be equally great. … Stockpiles of medical supplies must be made available.”

In the following pages, you’ll read Brown’s first-person account and the stories of several other providers who lived through Katrina, providing care to thousands of patients in the direst of circumstances.

 

RIDING OUT THE SURGE

Pennsylvania paramedic Valarie Ziminsky, stranded after her flight home from an EMS conference was cancelled, hooked up with New Orleans EMS as Katrina hit. Below is her description of events taking place on Aug. 29:

“We began talking about getting out of the building and quickly realized we were going to need to be rescued ourselves. …

“Earlier in the day, one of the police officers bunkered in with us had fallen down a flight of stairs and sustained nasty tib/fib and ankle fractures. It became necessary to give him pain relief. He was constantly monitored by two New Orleans paramedics, but we needed to get him out of the building and on to more definitive care. It was also a concern that he was an IDDM and had sleep apnea that necessitated a CPAP device, which we didn’t have available.

“To further complicate the task of rescue for not only him, but for the rest of us, was the fact that the city’s communications system failed earlier in the day, and we were unable to contact other EMS or fire service personnel.”

Late that night, a boat from Wildlife, Fish and Game arrived at the dental school where the group was stranded. “With many hands providing lift assistance, the officer was carried down from the third to the first floor, through the water and out to the waiting boat. He was transported to an ambulance that was waiting several blocks away. We were pleased that at least one rescue was completed, but realized the magnitude of the problems EMS would face because this one mission took 10 hours to accomplish.”

 

BUILD IT & THEY WILL COME

Editor’s note: This lesson is from the perspective of WakeMed Health & Hospitals, Raleigh, N.C., one of many organizations involved in Katrina relief efforts.

When citizens see a medical team arrive in their community, they see the team as the authority—and as immediate relief. This means before the team can even get set up, patients will be there. Have a plan in place to begin treatment immediately on arrival on a smaller scale while the rest of your team works on the main structure. It will facilitate an instant level of trust within the new community, which goes a long way in emergency situations. —Coleen Hanson