Administration and Leadership, Columns, Major Incidents

Trapped on Urban Islands

Issue 11 and Volume 30.

This month’s JEMS gives you an emotional and educational look at several key aspects of the EMS response to Hurricane Katrina. Because of the size and scope of the storm, we chose to focus on firsthand accounts and elements of the catastrophe that other media have not reported on in great detail, as well as lessons EMS systems can take away from this historic incident.

Prehospital clinical medicine as we know it changed during Katrina. For the first time in modern EMS, major metropolitan crews became stranded along with their residents. Crews seasoned in hurricane response, ready to respond to the needs of their communities, suddenly found themselves trapped on urban islands, unable to respond even after the most damaging conditions subsided.

New Orleans EMS Director Juliette Saussy, MD, and Assistant Director Mark Reis were cut off from their personnel were forced to wade through waist-deep, feces­ and chemical-contaminated water to arrange for the evacuation of other personnel in various sections of the city.

The daily log of New Orleans EMS Supervisor Jacob Oberman and personal accounts of National Registry Director Bill Brown and paramedics David LaCombe and Valarie Ziminsky take you inside the shelters and evacuation centers. Their tales give you a sense of the frustration they felt when they couldn’t render the care and medications normally administered to victims in critical need.

Some patients couldn’t tell providers what their ailments were. Many evacuees were forced to flee their homes rapidly and couldn’t bring along their prescriptions—important physical evidence of their ailments.

It was a new scenario, with patients at a major U.S. incident who were inaccessible by EMS or tagged as “expectant” and set aside on luggage carts and in hallways. Encountering and leaving patients who were expected to die due to the unavailability of dialysis, insulin, inhalers and other commonly available drugs was a situation most responders had never before experienced.

You’ll learn how EMS providers were forced to clean and reuse needles to keep people alive. You’ll also read about people who rescuers believe fabricated medical conditions to get priority transport out.

And there were other fakers. A New Orleans police officer alerted tactical paramedic/police officers from the Cypress Creek (Texas) Advanced Tactical Team to a man claiming to be a physician from West Jefferson Parish. Driving a white hearse marked with red crosses, the man was collecting narcotics from drugstores throughout New Orleans. The team promptly detained the “physician” for questioning.

Then, as rescuers began to respond on dry land, continuing to sort real patients from those taking advantage of the disorder, they were met by gunfire from residents rebelling against police—and society in general. Responders were surprised, disappointed, frightened and forced to retreat by shots aimed at ambulances and responding helicopters—yet another emotionally challenging experience.

Unlike 9/11, no EMS personnel died as a direct result of Katrina, but EMS did experience significant losses as a result of her aftermath. All along the Mississippi coast, EMS and fire stations were obliterated, and EMS personnel were left homeless and separated from their families. In New Orleans, some EMS providers who evacuated as Katrina approached have decided not to return to the devastated city that once offered them the excitement and challenges of urban, high­call-volume EMS—a city that now faces perhaps a decade of reconstruction.

Katrina will also impact many of you as you experience swells in call volume generated by an influx of residents displaced by this year’s hurricanes. A multitude of lessons can be learned from Katrina, as well as Rita and Wilma. We ask that you read our accounts carefully and ensure that your service has contingency plans, transportation agreements and supplies in place to cope with similar incidents—and not just on paper.