Major Incidents, Operations

Arkansas Ambulance Agency Sends Special Response Team to Support St. Croix EMS Crews Post-Hurricane Maria

Issue 3 and Volume 43.

Special response team from Arkansas provides relief & support to local EMS crews after Maria’s devastation

Hurricanes Irma and Maria devastated the U.S. Virgin Island of St. Croix, destroying power lines, uprooting trees, collapsing houses and beaching boats along the island’s shore. Photos courtesy Andrew Ney

On Tuesday, Oct. 24, Pafford Medical Services Corporate Director of Operations Clay Hobbs asked me if I’d be interested in joining his company’s hurricane deployment assignment in St. Croix on the U.S. Virgin Islands.

I jumped at the opportunity. Little did I know that I’d face a hospital closing, a nearly deserted EMS system, failing electrical power and a multiple gunshot wound victim flagging us down all on the first day.

Pafford SRT personnel worked 48-hour shifts to ensure an EMT and paramedic would be staffed on each U.S. Virgin Islands EMS ambulance.

Integrating Personnel

At 6 p.m. on Oct. 25, 2017, I joined 11 other members of Pafford boarding the Garrett Memorial Church Bus to head from Hope, Ark., to Dallas, to catch a commercial flight to St. Croix the next morning.

At 4:00 a.m. the next day, we checked in a total of 28 suitcases and each of us carried on multiple bags and equipment—everything from monitor/defibrillators to ventilators and medications.

At 3:30 p.m., our flight landed on the runway of a storm-torn airport on the rural island of St. Croix—more than 2,000 miles from Arkansas.

We were greeted by the airport’s fire chief as well as U.S. Virgin Islands EMS Director David Sweeney, who briefed us on the current situation St. Croix EMS was experiencing.

Hurricanes Irma and Maria had devastated the island. Power lines were destroyed, trees were uprooted and many houses had collapsed—the Cruzans, as the island’s residents are known, were left in devastation.

Some of the EMS staff had decided to retire, as their homes were destroyed and they wanted to use this as an opportunity to move stateside and start the next chapter of their lives.

The rest of the staff had to change their 12-hour rotating shifts to 24-hour shifts to make sure two ambulances were always staffed. This caused staff to burn out quickly, as the call volume increased after the storm and they had fewer resources. They were in dire need of support and relief.

As a collaborative effort, the St. Croix Fire Department began to supplement the EMS agency with one firefighter per ambulance. But with little experience, they weren’t providing the needed relief. The U.S. National Guard supplied solider medics, having 4–5 personnel on an ambulance, all operating with vastly different experience, wasn’t the answer.

With the arrival of Pafford’s Special Response Team (SRT), the National Guard medics and firefighters were released from providing support, and the Pafford SRT provided an EMT and paramedic for each truck.

Roles for each provider were well-defined. A U.S. Virgin Islands EMS provider (EMT, advanced EMT, or paramedic) would navigate the ambulance to the scene of emergencies, communicate with dispatch, begin the documentation of dispatch and patient info, and fill out the billing form.

The Pafford SRT EMT and paramedic took the primary role in providing patient care and were responsible for completing the documentation before locking the chart. Rig checks conducted at the beginning of each shift, as well as restocking the ambulances with supplies were shared by all crew members. St. Croix EMS was able to return to 12-hour shifts with two fully staffed ambulances, one starting at noon and the other midnight.

On the fourth day of providing staff, one of the U.S. Virgin Islands EMS staff members failed to show up for work. The plan was adjusted, and Pafford SRT providers began working 48-hour shifts, to ensure an EMT and paramedic would be staffed on each truck no matter what the situation. The U.S. Virgin Islands EMS staff continued to work 12-hour rotations.

The Pafford Special Response (SRT) team packed up equipment and supplies in Hope, Ark., in preparation to assist EMS crews on St. Croix in the U.S. Virgin Islands.

A special response team from Pafford Medical Services and Virgin Islands EMS crews responded to an uptick in EMS calls, such as this motor vehicle crash. Nighttime was particularly dangerous because the island was pitch dark and a majority of the roads were blocked or severely damaged.

Operational Challenges

The U.S. Virgin Island EMS has four ambulances on the island of St. Croix, but staff only two. The two older Type 3 ambulances had mechanical problems, and the two newer Type 1 ambulances had issues with the PowerLoad systems. Pafford’s fleet manager ensured there were at least two operational ambulances.

Following the devastation of Hurricane Maria, ambulances had difficulty reaching multiple scenes because of the downed power lines and trees. U.S. Virgin Islands EMS management says that EMS wouldn’t respond to calls after a certain time because the island was pitch dark at night and a majority of the roads were blocked.

After Pafford’s SRT arrived, most of the roads were at least open to one lane, despite many being severely damaged and full of pot holes.

Dispatch communications on the island is much different than in the mainland U.S. There was no pattern to how communities were named and assigned numbers; and GPS wouldn’t work on the island.

For example, dispatch would page, “EMS, I need you to respond to X house number in William’s Delight for a patient experiencing a seizure.” EMS would respond and acknowledge the page.

Pafford SRT stored supplies in a room at the U.S. Virgin Islands EMS station.

When Pafford personnel ask for directions, U.S. Virgin Island personnel would respond, “Take a right at the shanty next to the Captain Morgan distillery, go over four speed bumps and take the sixth right. The house is beige in color, and it’s on the right with a red car out front.” Having U.S. Virgin Islands EMS staff navigate the roads was a must.

House numbers weren’t laid out in a set pattern on each street, but rather assigned in the order of when they were built. It was unlike anything I’ve ever experienced.

After a few days on the island, we learned that Gov. Juan F. Luis Hospital was heavily damaged by Maria and might be condemned. Western Shelter tents were going to then be set up in the parking lot and staffed by FEMA Disaster Medical Assistance Teams.

One of the unknowns for an EMS deployment such as this is estimating the necessary supplies and equipment to bring. Our 28 suitcases were filled to the brim with trauma dressings, fluids, gloves, suction canisters, catheters and tubing, medications, ECG electrodes and 12-lead cables, defibrillator pads, ventilator tubing, thermometers, lancets, syringes, batteries, OB kits, oxygen devices and tubing, disposable CPAP, hand soap, rain jackets, safety glasses and more. We stocked four jump bags and four pediatric bags. We carried on three monitor/defibrillators and one ventilator. U.S. Virgin Islands EMS personnel was happy to see we were prepared for anything.

The Pafford SRT staff stayed on a cruise ship on the Frederiksted Pier on the west side of the island, alongside FEMA workers and air medical staff. Each crew partnered up to one room that contained two beds and a bathroom. Two food areas were open on the ship to get breakfast, lunch and dinner on our off-shift days.

It was comfortable; however, I was empathetic for the U.S. Virgin Island EMS staff, who continued to stay in their homes without power.

After a few weeks of working together, the teams working on each ambulance were solid. We all knew what we needed to do for each of our patients. Not only did I get to know the U.S. Virgin Islands EMS staff, but I also forged friendships with Pafford SRT staff that I barely knew prior to this deployment.

The Pafford SRT staff stayed on a cruise ship on the Frederiksted Pier on the west side of the island, alongside FEMA workers, linemen and air medical staff.

Coming Home

I returned home to my job at Paramount Ambulance in Dubuque, Iowa, on Monday, Nov. 27. The long 30-day deployment to the U.S. Virgin Islands was an unforgettable experience. I’ve made multiple friendships that will last a lifetime.


Acknowledgement: I would like to thank Clay Hobbs and Jamie Pafford-Gresham for giving me this opportunity as well as acknowledge the Pafford SRT members I had the privilege to work with and whom I now consider my friends: Andrew Amante, Eric Ryan, Mallory Ryan-King, Jaret King, Eric Street, Josh Forrest, Suzie Gresham, Dusty Rogers, Nash Lindley and Leon Cheatham. I would also like to send thoughts and prayers out to the families and friends of three members of Pafford Air One Bravo, who passed away on Nov. 19, 2017, in an air ambulance incident while responding to a call: Flight Nurse Jim Spruiell, Flight Paramedic Trey Auld and Pilot Mike Bollen.