Thanks to stranded physician, Dr. Tran Vo from New York, for helping our medics in the Superdome.

Transcription

1 T h e K a t r i n a D i a r i e s : F i r s t H a n d A c c o u n t s f r o m M e d i c s a n d M i r a c l e W o r k e r s b y R o s s J u d i c e, P L L C

2 Acknowledgements Many people contributed generously to the creation of this book, and I am grateful to them all. Thanks to those who helped edit the text and suggested ways to improve it. Terry Daniel played an important role in the first draft. Thanks also to her assistants, Chrystal Wadsworth and Annette Brown. Thanks to the stranded medics that helped in the Superdome: Stephanie Korzyk (New York), Mark Gerano (Ohio), Vickie Kock (Ohio), Sean Schuman (South Dakota), Duane Quakendosh (South Dakota), Phillip C. Yellow Hawk (South Dakota), Deanna Lassegard (South Dakota), Rob Menacher (South Dakota), and Will Howland (Louisiana National Guard). Thanks to stranded physician, Dr. Tran Vo from New York, for helping our medics in the Superdome. Thanks so much to my family who have been a continuous source of support throughout my life, and especially during the trying times of Hurricanes Katrina and Rita. Special thanks to my three brothers - Ronnie, Roch, and Remi - who jumped on a helicopter at a moments notice...to help me at the Superdome. Seeing them arrive at the helipad confirmed what I already knew - I have a great family. Thanks also to Robin Roughton Judice, my wife, who not only supported this writing project, edited the book, but also kept me emotionally grounded during the aftermath of these storms. Thanks to my dad, Ronald Judice, Sr., for proofreading and editing the book, and for teaching me to be courageous. Thanks to the men and women of Acadian Ambulance Service who inspire me every day with their compassion and professionalism. For reaching into the misery of Hurricane Katrina and pulling so many people out of despair, I dedicate this book to them, and to all the first responders and EMS personnel that pulled together to help. 2

3 Contents Introduction 4 Prologue: The Lay of the Land 8 By Air, Land, & Sea 16 Life and Death on the Interstate: The I-10 and Causeway Cloverleaf 25 The Children 32 The Elders 39 Rescuers in the Storm 45 Sick, Disabled 59 The Animals 64 Superdome 67 Crime 80 St. Bernard 87 Organizing Chaos 90 Difficult Communications 103 Reflections 107 Epilogue 113 3

4 Introduction There have been dozens of books written about Katrina, the Category 5 hurricane that leveled long stretches of the Gulf Coast from Florida to Texas and decimated the city of New Orleans in August The story has been told countless times by survivors, politicians and journalists who were there on the front lines, witnessing the devastation as it happened. Their stories express the unimaginable horror of seeing the bodies of dead men, women, children and animals floating in the putrid floodwaters. They tell of personal loss, grief and devastation. They shine a harsh light on poverty and politics. It has been five years since Katrina, and most of us have heard it all. But this story is different. We are the paramedics, EMTs, doctors, nurses, administrators, support staff and volunteers who were on the scene before, during and after Katrina. We were present from the pre-storm evacuations, during the storm, and throughout the surreal and unexpectedly tragic aftermath. The accounts you will read in these pages are told first-hand by healers...the people who treated the wounds of the traumatized and injured, held the sick and dying in their arms, and did their best to create a haven of safety in the midst of terror and chaos. Katrina gave us an extraordinary new!perspective on the work we do.!we are accustomed to school bus accidents, murders, heart attacks, suicide attempts and human suffering of all kinds. We are used to pulling mangled bodies out of multivehicle car crashes, but we!never imagined that Katrina would require us leave our ambulances and offices and face the unknown to care for a sea of suffering New Orleanians. We also could not anticipate that some of the people we were trying to help would end up shooting at us, or that we would run short of supplies, medicine and equipment. In the Emergency Medical Services (EMS) business, Katrina is what we call a mass casualty incident." But we -- along with most everyone else in the southern states -- never expected it to elevate to such a desperately critical level. Medics compared it to being in a combat zone, and many of the military medics who worked alongside us said that they'd never seen anything like it. From 1998 to September 2010, I served as the medical director of Acadian Ambulance Service, Inc. ( Acadian ). 1 Acadian is based in Lafayette, LA 135 miles west 1 At all times pertinent to this narrative, the author served as medical director of Acadian and continued as such until September hence the use of the terms we, us, and our when speaking of Acadian and its staff. 4

5 of New Orleans. Most of us rode out the hurricane in our own homes. After the storm passed, we walked outside to find blue skies and gentle winds blowing, just like any other summer day in Louisiana, and it seemed that the area had emerged relatively unscathed. But that was before we knew that the levees had broken and the low-lying areas of New Orleans were beginning to flood. There was no electricity or phone service, so news of the flooding didn't reach us until the next morning. As I packed to accompany our paramedics into New Orleans to begin our medical relief operations, I threw my video camera into my duffle bag with the intention of videotaping some of the work we d be doing. I didn t realize at the time that I would be way too busy to carry a camera around. In fact I didn t even open the bag until three or four days later. I was disappointed that I had not been able to document something that most people never see the medics point of view. Then I got an even better idea. I sent one of my employees in Lafayette to purchase ten digital voice recorders from a local electronics store. I handed one of these recorders to each of my key staff members with these simple instructions: record your experiences and impressions. They in turn passed the recorders on to others so that the first hand accounts would be captured. The stories in this book are transcriptions of those recordings. I recognized that this was a disaster like no other, and I wanted to make sure the world knew how it looked through the eyes of the emergency medical personnel on the scene. Some of the people you'll meet in these pages have worked in EMS for decades. Some lost their homes, their possessions, and their pets in the storm. Most worked 20 or 30 hours non-stop in the Superdome, on the freeway underpass that became a makeshift triage 2 center, in helicopters, in ambulances, in boats and in our offices, doing whatever needed to be done to meet the needs of an entire city of refugees. The intent of the book is to document both the deep compassion and the frustration of Acadian's responders. The stories told by these medics and staff will shock you and touch your heart with their expressions of brotherly love, human kindness and human vulnerability. Although I am extremely proud of my Acadian colleagues, there were countless others who helped with equal dedication. Some of those include the Coast Guard, the National Guard, FEMA, hospitals, EMS, medical professionals, civilian helicopter companies, churches, civic organizations, local businesses and local fire & police departments. Then there were the friends, neighbors and average folks who helped by cooking meals for our medics, bringing us clean clothes, offering their boats, tools and manpower and assisting us in a hundred different ways. 2 Triage is the assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties. Medics are trained to triage patients in disaster situations. 5

6 The stories being published herein have not been confirmed or endorsed by Acadian as to their accuracy or content. Acadian takes great pride in the work and dedication of its employees, not only in times of disaster but every day that they commit themselves to a mission of service. In looking back on the days and weeks and months following Hurricanes Katrina and Rita, there was an overwhelming degree of humanity, persistence, skill, integrity and endurance that was displayed in the field and at home. The faces of those whose lives were touched and who touched every member of the Acadian family in the wake of those storms will never be forgotten. We walked with angels during that time. We were reminded that material things can be washed away, but that the human spirit is eternal. Ross Judice, MD 6

7 G r e a t e r N e w O r l e a n s C a u s e w a y & I N. O. E a s t A i r p o r t S t. B e r n a r d S u p e r d o m e S u p e r d o m e & A r e n a H e l i c o p t e r L a n d i n g F i r s t A i d S t a t i o n i n S u p e r d o m e D M A T i n A r e n a I m a g e s s o u r c e : G o o g l e E a r t h

8 Prologue: The Lay of the Land As you read, you will see numerous references to locations such as the Superdome, the Arena, the I-10/Causeway cloverleaf, St. Bernard Parish, Lafayette and other sites that figure prominently into the story. You will also read medical terminology that you may not understand as you read the first-hand accounts from medics. This prologue will provide a valuable key to understanding the sequence of events and some of these references. A day-by-day timeline is set forth at the end of this Prologue. Acadian Ambulance has had the first aid station and standby contract with the New Orleans Superdome since During football games, rock concerts and other events at the Dome, a core group of our medics is based in a small first aid area on the middle level of the Superdome, while others are scattered around the stadium. When it became clear that a monster hurricane was due to hit New Orleans on Monday morning, the city ordered a mandatory evacuation and set up the Superdome as a refuge of last resort for people who needed a safe place to take shelter from the storm. As the contracted medics for the Dome, we manned our usual post on Sunday, and because the high winds could potentially blow out the glass doors at all the Dome s entrances, we parked an ambulance in front of each door to serve as a wind barrier. Then we watched the Dome slowly fill with people, mostly the poor, elderly and indigent who didn t have cars to take them out of town or money to stay in a hotel on higher ground. Besides the medics stationed at the Superdome, other members of our staff were busy evacuating patients from hospitals and nursing homes and taking them to other hospitals in safer areas. The evacuation effort went smoothly given the massive scope of the effort. By Sunday night we d moved most of the patients and returned to our homes to hunker down with our own families until the storm passed. Coincidentally, the annual EMS Expo and conference was being held in New Orleans that weekend. This is North America s largest gathering of emergency medical personnel, and there were perhaps 2000 paramedics, nurses, doctors and other emergency medical practitioners in town. Acadian had quite a large presence there; many of our staff members were in attendance. We were also exhibitors at the expo and provided speakers at the conference. Throughout the conference everybody watched the news and kept abreast of the storm s movements. By Saturday night the winds had changed and Katrina was heading directly toward New Orleans. When the mandatory evacuation was an- 8

9 nounced, some conference attendees managed to get early flights out. Many others found themselves stranded at either the hotel or the airport once all the flights had been cancelled. Car rentals were the next option, but the roads were jammed with evacuees and it took five hours to travel a distance that normally took one hour. As a result, hundreds of EMS people were left in New Orleans, and many of them pitched in to help. Several came to the Dome with us. As an interesting aside, my wife and I had just sold our vacation condo in the French Quarter. We d spent most of that week packing up our belongings to take back to our home in Lafayette, where Acadian is headquartered. I recruited some of our guys who were in town for the conference to help us move. We had everything loaded up and were able to get out of town just minutes before the evacuation order came in and the traffic started to back up. The storm hit on Monday morning as expected. Back in Lafayette it wasn t too bad, and after the storm had passed, things appeared to be calm and under control. But by mid-morning in New Orleans the lower 9th Ward levee breach poured 6-8 feet of water in that neighborhood. By mid-afternoon, the 17th Street Canal breach flooded 20% of the city. Severely damaged communication systems limited information to the outside world. It wasn't until late Monday night and during the early hours of Tuesday morning that our dispatch center began getting scattered reports about the extent of the flooding and devastation. Now, 80% of the city was flooded. We immediately jumped into high gear. The first order of business for Acadian was to begin mobilizing flight medics to fly our helicopters to New Orleans to assess the situation at the hospitals. We also needed to relieve the staff that had been at the Dome s first aid station since Sunday. I assembled a group and we traveled by helicopter from Lafayette to New Orleans. We could not believe what we saw on the ground as we flew over...the city was an enormous lake. Nobody expected the levees to break (except the engineers and experts who d predicted it years earlier, but that s another story). Because there was no power, communications were crippled, so nobody knew what the conditions were from one location to another. The landlines were all down. Few cell phones worked because the towers that hadn t blown down were operating on generators. Those generators eventually flooded too. Luckily we had satellite phones and were able to acquire some radios and other communications equipment over the next several days. After we arrived at the Superdome, the population of refugees starting growing. Thousands of people were arriving, wading through chest-high water to get to the only shelter they could find. Our little first aid station provided the only medical care available to the public at that point, and we quickly realized that this would not be enough. The Dome is an enormous place, but thankfully, we had two or 9

10 three Gators, which are like golf carts that function as mini-ambulances. We drove them around the Dome picking up the sick and injured and taking them back to our first aid station. We were inundated with requests for help inside and around the Dome. Sometimes we left the first aid station by foot or in the Gator to assess and triage people: in the football stands, hallways, on the field, outside, or wherever we were needed. Mothers arrived with their babies, sons with their mothers, wives with their husbands - most with worsening chronic medical conditions like diabetes and heart disease, and others with mild traumatic injuries from the rough conditions wading through the flood waters. The demand for medical care soon outweighed our ability to supply it. Conditions in the Dome were rapidly deteriorating. We didn t yet know that one of FEMA s Disaster Medical Assistance Teams (DMAT) had arrived and set up a treatment station at the New Orleans Arena. The Arena is a smaller building next to the Superdome where the NBA s New Orleans Hornets play (see the site map at the back of this book). The two arenas are connected by a raised walkway. News of the flooding and the increasing number of refugees was spreading, and rescue teams were beginning to arrive from all over the country. We sort of stumbled upon the DMAT people. When we realized they were there we collaborated to create a system for transporting serious patients to their station, which was better equipped to deal with critical medical issues. Soon the DMAT area filled up with patients, and there was no place to keep them and no way to evacuate them. There were not yet helicopters and only limited military assistance. I called our dispatch on the satellite phone and asked them to send our six helicopters to the Dome so we could move patients to hospitals, but all our helicopters were busy in other parts of the city. A few minutes later I got a call back saying that some medically-equipped helicopters owned by Petroleum Helicopters Incorporated (PHI), which primarily serves offshore oil rigs, had arrived at the Dome to help out. Because communications were so bad and the Superdome was so big, nobody knew that these PHI helicopters had landed, and their nurses and medics didn t know where to find us. I made my way over to the Superdome helipad and there they were, waiting for instructions. Finally I had an idea where everybody was: our first aid station was inside the Dome, the DMAT area was in the Arena, and the PHI helicopters were at the helipad. It was time to start connecting the dots. We had some portable radios...the guys on the Gators had one and the first aid station had one, so I positioned one of my staff at the DMAT area with a radio, and positioned myself at the helipad to begin directing traffic. 10

11 The Gators buzzed around the Dome picking up people and bringing them to our first aid station. The critical patients were transported along the elevated walkway to the DMAT area. After they were treated at DMAT, they d be put back into the Gators and driven over to the helipad. From there they were flown to a makeshift hospital at Louisiana State University s basketball arena (the Pete Maravich arena nicknamed the P-Mac ) in Baton Rouge. This system worked, but only for a short while. The flight from the Superdome to the P-Mac was a 90-minute round trip flight, but we soon ran short of helicopters because the number of patients was increasing by the minute. We couldn t be without our helicopters for that long. Earlier in the day, Acadian leaders dispatched 30 extra ambulances to a staging area that we d set up at the Interstate 10 overpass at Causeway Boulevard in Metairie. It was only a six-minute helicopter flight from the Dome to I-10/Causeway and outside the floodwaters with a direct drive to Baton Rouge. The overpass was in a cloverleaf configuration, and it turned out that each of the cloverleaves could serve as a helipad. It was a brilliant solution. The helicopters could take people from the Superdome to this new site and be back in six minutes to pick up another load. When we set up on the I-10, thousands of people started showing up. Word was out that we were there, and people started coming from everywhere, wading through the water in search of dry ground, medical care, food, water, shelter...any relief they could find. Rescue helicopters began dropping people off there. Soon the I-10 cloverleaf was a mess. Back at the Dome, military trucks started arriving with intensive care unit vent patients who d been evacuated from hospitals. These are patients who cannot breathe on their own and rely on electrically powered ventilators to move air in and out of their lungs. Without a ventilator, they die immediately. When someone like this is rescued, they have to be bagged, which means that a manual breathing apparatus is used. It looks something like a bellows with a tube that blows air into the patient s lungs. The bellows, or bag, has to be squeezed by hand to keep the air flowing. These ventilator-dependent patients became a priority over the Superdome patients, and put in the front of the line for helicopter evacuation. We later heard many stories about hospital staff members who took turns for hours on end bagging ventilator patients after the electricity went out. Many hospital employees chose to stay at their hospitals rather than go home to ride out the storm, because a hospital is a usually safe place to be in an emergency. Some of these employees even brought their families, so there were plenty of helping hands when it became necessary to bag patients. Even the teen children of the staff members were enlisted to help with this task of bagging the patients. Because many of 11

12 these patients were terminally ill, some people disagreed with the decision to bag them, believing it would be more effective to use the manpower elsewhere. At the Dome there had been reports of rapes and murders, and we d heard that snipers were shooting at anybody in uniform. A fog of war set in as the National Guard MP's warned us that the generators would soon flood and the lights would go out, and the criminal element would take advantage of the dark to attack us and steal our medical supplies. The MP's advised us to remove our command vests, hide our stethoscopes and try to blend into the population so we wouldn t be targeted. We formulated an escape plan in case of rioting which instilled an enemy out there mindset that stirred my staff into a panic. There were tens of thousands of people in the Dome, many of them were sick and dying. There was no electricity, no plumbing, limited water and food. People were urinating and defecating wherever they could. Between the smell of human waste, sweat and death, and increasing fear, it was unbearable to be inside. By Wednesday there were military and Coast Guard helicopters, plus our fleet, the civilian helicopters and Hueys, and Blackhawks as far as the eye could see. Ambulances came from different companies around the county. All we did, day and night, was move patients out of New Orleans as fast we could. FEMA established a field hospital at the New Orleans airport, and by Thursday we were able to fly people directly to the airport, where they would be sent to various hospitals around the region. We moved our first aid station outside with an MP escort. The DMAT people were still in the Arena, which was more secure, but there were now thousands of sick and injured patients needing help, and they were getting sicker all the time. People fled their homes without bringing their prescribed medications, and if they did bring their medications, the pills got soaked as the people walked through the water. There were un-medicated psychiatric patients, dialysis patients, diabetics, elderly people having strokes and heart attacks, sick children, women giving birth and people dying from dehydration. It was a nightmare. By Thursday, with rumors of crime escalating, we decided to vacate the premises and move our entire operation to the field hospital on the I-10 cloverleaf. There were so many people being transported that we d long since abandoned the protocol of setting up medical charts and collecting personal information about the patients. We were loading people into helicopters and flying them out so fast there just wasn t time to keep track of them. Family members didn t know where their loved ones were being taken, and neither did we. People were transported to hospitals and shelters all over the Southeast with without records, but there was nothing 12

13 we could do about it. At this point, nothing mattered more than getting those folks out of the Dome to safety. Below I ve included a timeline of events relevant to our story. Naturally, this is not an exhaustive list of what happened, but will provide some big picture context to the stories that follow. Hurricane Katrina Timeline Friday, Aug. 26, 2005: Louisiana Governor Kathleen Blanco declares State of Emergency Saturday, August 27, 2005: New Orleans Mayor Ray Nagin declares State of Emergency. Orders voluntary evacuation where residents in low-lying areas encouraged to evacuate Sunday, August 28, 2005: Hurricane Katrina becomes a Category 5 storm with 160 mph winds Superdome opens as a shelter of last resort Acadian personnel are deployed to the Superdome to help triage special needs patients and staff the first aid station Nagin announces that buses will pick people up throughout the city and take them to the Superdome Nagin orders mandatory evacuation of the city Superdome now has 10,000 people inside and 150 National Guardsmen stationed inside (most are unarmed) National Weather Service predicts levees may be overtopped Monday, August 29, 2005: At 6:10 a.m. Hurricane Katrina becomes a Category 4 storm with 145 mph winds and makes landfall Lower 9th Ward levee is breached with reports of 6-8 feet of flooding 17th Street levee is breach with reports that 20% of the city is flooded People continue to arrive at the Superdome despite its being damaged in the storm Phone and out of New Orleans is limited due to flooding, and many believe New Orleans has dodged a bullet Tuesday, August 30, 2005: Floodwaters have risen overnight and the city is 80% flooded Acadian deploys 50 ambulances to the Interstate-10/Causeway Boulevard intersection and establishes helicopter landing zones and medical triage center. Helicopters arrive here with rescued victims. 13

14 Acadian deploys 7 of its air ambulance helicopters to evacuate the most critical patients from New Orleans hospitals. Other air medical transport companies send helicopters to assist in the evacuations. As requested by state administrators, Acadian s dispatch center begins coordinating and deploying all civilian air medical resources in the affected areas Dr. Judice and Acadian medics fly to the Superdome to support and replace existing Acadian personnel Air evacuation of ill and injured patients at the Superdome begins FEMA activates the National Response Plan to fully mobilize federal government resources Reports suggest looting is widespread Wednesday, August 31, 2005: Massive air evacuation of ill and injured from the Superdome continues. Population taking refuge in the Superdome now thought to be over 25,000 Air evacuation continues at Tulane Hospital & Baptist Hospital as well as Touro Hospital and Children s hospital Acadian dispatches liaison to Belle Chasse Naval base to assist in air asset coordination Twenty-seven (27) civilian and 12 military helicopters assisting in evacuation of medical patients in the city Thursday, September 1, 2005: Acadian staff is evacuated from the Superdome due to security concerns Touro Hospital administrator phones saying he and patients slept on the roof waiting for help. Acadian sends helicopters Most of Tulane Hospital evacuated but still working on Charity Memorial Hospital & University Hospital air evacuation continues Marc Creswell set up night landing zone at Children s Hospital Received call from Meadowcrest in Gretna that there were 120 people still left in the hospital Triage center moved from 1-10 and Causeway to Airport Friday, September 2, 2005: Evacuations of patients from hospitals completed around 1:00 p.m. Acadian staff enlists three 18-wheelers to complete evacuation of 48 patients plus staff at Charity Hospital Acadian provides ambulance support to FEMA s Urban Search & Rescue operation in New Orleans East. Help evacuate forgotten nursing home patients Fifteen airlines begin flying refugees out to various cities around the U.S. Buses arrive at the Superdome to evacuate refugees 14

15 I now respectfully turn the story over to the dedicated EMS personnel. Together, we will tell you in the following pages and in our own words, exactly what we experienced during the Katrina rescue and recovery. 15

16 By Air, Land, & Sea On Saturday, August 27th 2005, two days before Katrina made landfall, New Orleans Mayor Ray Nagin declared a state of emergency and suggested voluntary evacuation. The next day, as the storm turned toward his city, evacuation became mandatory. By Sunday afternoon Acadian Ambulance was swamped with calls from hospitals and nursing homes requesting evacuations for their patients. Outbound traffic from New Orleans was bumper-to-bumper, substantially lengthening trip times and tying up ambulances in standstill traffic. Additionally, as the storm drew near, the boxy ambulances became unsafe to drive in the high winds. Later, the rising floodwaters made ambulance transport impractical, if not impossible. The lower areas of New Orleans flooded first, including the Lower 9th Ward and Saint Bernard Parish. Volunteers, along with local police and fire department rescue teams combed the landscape in boats, but air rescue got off to a slow start because military and FEMA helicopters did not arrive on the scene until three days after the storm. The Coast Guard and helicopters picked up the slack from private companies. Acadian s small fleet worked nonstop, and there were a few National Guard helicopters flying patients from the Superdome to hospitals in nearby areas. But it wasn t until Wednesday that Coast Guard and National Guard arrived in full force. After that, air-traffic was so thick it was precarious to fly over the city. Phone calls in and out of New Orleans (504 area code) and Baton Rouge (225 area code) were challenging because of flooding (New Orleans) or the phone network being overwhelmed (Baton Rouge). More open lines of communication in and out of Lafayette (337 area code) made Acadian s dispatch center a hotline for desperate victims of the storm and their concerned family members across the U.S. Mike Burney, Dispatch Manager On Sunday morning, the day before the storm, we got word that Orleans Parish and St. Bernard were going to issue mandatory evacuations. We had maybe 30 units ready to move patients from nursing homes and hospitals, but once we got those patients on board, the streets were gridlocked because there was so much evacuation traffic heading out of town. Shelters were opening up in Alexandria, and the trip there normally took four hours, but now it was closer to eight hours, so a lot of our units were just sitting in traffic. They were trying to get patients as far away from New Orleans as they could. By Sunday afternoon we had more calls than we could actually handle - many from residences with special needs patients who were handicapped or requiring special 16

17 assistance and equipment. Even on Saturday we had residential evacuations calling in, and we were inundated with requests. We struggled to get as many people out as possible, but we had to put facilities, hospitals and nursing homes ahead of the residential calls. We tried to utilize what we resources we had, and put as many people in each unit as we could. At 8 a.m. Sunday morning the Superdome was opened up as a shelter, so instead of taking patients out of town, we started taking them to the Superdome, which initially helped out tremendously. A lot of patients weren't happy about being taken there, but they had no choice at this point. It was the Superdome or nothing. After a while we started losing more units, because so many were transporting patients long distances to hospitals in central Louisiana. That was about an 8-hour round trip, so that put most of our ambulances out of commission. By 4 p.m. the decision was made to cease ambulance operations and get our personnel and equipment out, because the storm would soon be bearing down on us. In 50 mile per hour winds, ambulances are unsafe because they are box-type modules that can topple over. By 6 p.m. we had pretty much shut down. Some of our ambulance crews were positioned at hospitals, emergency operations centers (EOC), and hospitals to ride out the storm. And some were at the Superdome, where we had a first aid station set up. Monday morning the hurricane came through, and the next day, Tuesday, we started hearing about flooding in St. Bernard Parish. I think that's when we realized that they were in trouble. We knew that the levee in St. Bernard broke during the hurricane and there was massive flooding, and we were very concerned about nursing homes that refused evacuation. We were getting reports from paramedic Janie Fuller, who was at the EOC in St. Bernard, that the flooding was pretty bad. At one point she advised us that a Greyhound bus had been parked outside and she could only see the top of the bus because the water had come up so much. Tuesday morning we resumed operations under what seemed like normal circumstances, and we were preparing to bring patients back into the city. But now the city was flooded and ground transport out was going to be a problem. Dispatch supervisor Mike Sonnier had determined that none of the helipads at the hospitals were functional for various reasons, and we even heard that one of the helipads had been blown off the top of the building, so air transport would also be a challenge. Mike instructed personnel at Tulane Hospital to cut down the light posts on the top level of the parking garage so we could use it as a helipad. From that point on we started getting hundreds of calls from hospitals with every imaginable crisis on their hands. There was no electricity (some were operating on 17

18 generator power), and there were NICU babies and ventilator patients coming from every hospital, while the water was continuing to rise. I remember one hospital calling to say that they were out of oxygen, out of power and the generator was not working. On Tuesday we started flying the NICU babies out, and also the vent patients from Tulane, and we told the other hospitals that we'd asked the state to provide us with boats so we could go to the outlying hospitals, pick up patients and bring them to our improvised helipad at Tulane. We worked on that for the next two days. Mike's idea to cut down those light posts was genius. He is a former Air Med medic and he knew that if he could get those poles down we could use that as a landing zone. That is basically how we evacuated the hospitals. University and Charity hospitals were sending patients by boat to Tulane and getting them up to the third floor of the parking garage so we could airlift them out. FEMA called us on Tuesday to ask that we take over management of the civilian air rescue helicopters. In other words, if another agency such as Miami Flight offered to help out with their helicopters, FEMA wanted us to coordinate with all of those. So we started doing that. We would assign them a mission and they would take care of it and then call back to ask for their next mission. It was going pretty well at that point. Flight paramedic Marc Creswell was coordinating that at Tulane, and at one point a FEMA representative came up to him and said, "OK, we have it now, and we ll take over." So we turned it over to them, ceased our operation there and moved Marc to another location. We were dismayed to hear later that after we left, things kind of shut down in terms of a continuous flow of patients. We'd been also taking patients to the airport, where they were scheduled to get on C-130s and fly off to various locations. But the babies, being NICU babies, flew straight to Lafayette Women s & Children s Hospital, and some to Baton Rouge. That went well when we were doing it by ourselves, but when FEMA came in, there was another slowdown, according to some of the hospitals. It just wasn t moving fast enough. By Thursday morning, day four, we were still trying to get patients out of hospitals, but we had to also start evacuating our own personnel from the Superdome because it was no longer safe for them to be there. I got a call from one of the guys at the Dome, and I heard the urgency in his voice. He said, "Come get us out of here because it isn't safe." We had Air Med 1, 2 and 6 at our home base in Lafayette, so we sent them to move our people from the Superdome to a field hospital we'd set up on Interstate 10 at the Causeway off ramp. 18

19 Jay Boudreaux, Paramedic Dispatcher We made a couple of unsuccessful attempts to get to the Superdome by ambulance to drop off supplies on Tuesday, but the water had risen and was continuing to rise. As we were driving through the city people on every corner flagged us down. I had a patient to transport, and we had to figure out if there was an open hospital anywhere, which was a challenge in itself because there was no radio communication. We took a stab in the dark and went to West Jefferson, and they were open. Patients were being evacuated by boat and being brought in by helicopter and emergency vehicles. They did have some ambulances transporting to the triage area at the I-10, but the majority were coming by military aircraft. The on ramp there at the I-10 and Causeway is a cloverleaf, so they were landing on the cloverleaves, and the ambulances were frantically unloading the helicopters one right after another. Tuesday night paramedics, Henry Rivet, Todd LaPorte and I tried to get back to the Dome with medical supplies. We drove a rental truck that was much higher than an ambulance and could drive through the water. We got within three blocks, but then we couldn t get any closer, because if the truck stalled then we would be forced to sleep there, and that wasn t a good thing. So Henry and Todd decided to put the supplies, including hamburgers cooked at the Gretna station, in an ice chest and float them over to the Superdome. I waited in the truck, and that was the longest 40 minutes of my life, sitting in the middle of flooded Tulane Avenue in the dark with no idea of what was going on in the city or when Todd and Henry would come back. Thursday morning, I went out to I-10 and Causeway, but then Erroll called and asked me to go to the Superdome to coordinate with the military to evacuate patients. One of the Air Med helicopters flew me in. So I went to the heliport to coordinate with the military. Those guys take care of their business really well, but they weren t getting adequate information about where their helicopters were needed. Those guys evacuated a lot of people eventually, but early on they weren t doing much because they just didn t have the information. Working with the military was interesting, and they did a really, really efficient job once we were all on the same page. On Thursday, along with the hospital evacuations, we evacuated 130 medical patients from the Arena, and when I got back there Friday morning, I heard 200 more had come in during the night, as overflow from the Dome. 19

20 One of the big challenges was that the hospitals in the downtown area don t have heliports. Normally when we transport to those hospitals, we land at the downtown heliport and take an ambulance the last four or five blocks, but this wasn t possible because of the water. At one point we ended up converting the top floor of the parking garage at Tulane hospital into a landing zone by tearing down the light poles. From there we were able to get patients from Charity Hospital, University Hospital and the VA to the top floor of the Tulane parking garage and fly them out from there. Marc Creswell, Flight Paramedic Prior to the storm we got a request from Renaissance, a nursing facility in St. Bernard Parish, to evacuate their patients. We flew eight or nine people to Yazoo City, MS, and left there when the winds got to about 40 miles per hour, and it was a risky maneuver trying to get out of there in those winds. We dropped the aircraft off in Alexandria to secure it for the night, and a fixed-wing aircraft brought me back home to Lafayette. Tuesday morning we found out about the flooding and everything went crazy. That's the day that we ended up pulling down the light poles at the top level of a parking garage at Tulane to make a landing zone. This helped us get their critical patients out quickly, using mostly Acadian aircraft, and it wasn t until much later that we got any help from outside agencies. We kept on flying and flew quite a bit of the night and I bedded down there at Tulane. We went to Children s Hospital the next day, and then to Memorial Hospital to evacuate more people. We were taking patients in droves, with no destination hospitals assigned, no charts, no reports we were just grabbing people and taking off with them. By Thursday morning we finally had some military help, and we worked our teams to death, made double time everywhere. I ran those nurses and doctors into the ground, but we managed to get people out fairly quickly. We must have turned over patients, just bringing them all over the place. I was called to go to a hospital called St. John s, which was a long-term acute care facility, and it was a really desperate situation. They were flooded and had been out of power for a while, and there were nothing but women there. There was only one guy a security guard with no medical knowledge, and he had a handgun for security. They had 27 patients and 11 or 12 deaths, and the bodies were stacked on the first floor. 20

21 Later on I was summoned to Meadowcrest, which is a hospital toward the eastern part of Orleans Parish. They had just started evacuating people and were desperately looking for someone to lead them out of there. We found out how many they had, where they were going and what they needed, but we didn t have a landing zone there. This was one of those times when we had to improvise, so we found a parking lot across the street that had a bunch of trees in it, and I managed to find a tree saw. Cody Schuff, a couple of other guys and I worked together to cut all those trees down -- probably a dozen of them -- in about 30 minutes. We were wearing ourselves using a handsaw, and after about 20 minutes, a guy from a utility truck comes by with a chain saw and offers it. He said, I ve been watching y all struggle with that hand saw, and thought you might need this." He got there as we were cutting the last tree, and we had to wonder why he stood there watching us for so long before coming over with his chain saw. Anyway, we cleared the whole place out and made a night landing zone area. We lit the place up like a Broadway show, and things really started picking up. PHI was dropping four helicopters on us about every 40 minutes. Blackhawks, Hueys, you name it. Every known aircraft was in and out of there till about 11:00, until it got too foggy. After the fog came in, we started trucking those people out of Meadowcrest. We had six heavily armed guys from the Jefferson Parish Sheriff s Department for security, and a dozen ambulances. The staff at Meadowcrest had emptied out their freezers because there was no electricity, so they took all the meat out and put it on ice. So here we were working like mad, and suddenly the hospital staff gives us all this meat: pork chops, tenderloins, chicken and sausage and what not. There was a guy named Captain Mike from Lafayette who rigged up a barbecue and started cooking for us, and he brought his own brand of seasoning. If you ever hear of Captain Mike s seasonings from Lafayette, go buy it, because it is the best. I swear I ate so much barbecue I thought I was going to turn into a Texan. I found a bed in the Meadowcrest emergency room and slept there. Woke up the next morning to the smell of barbecue, so I engorged again. The name of the game in New Orleans during this whole time seemed to be that if you see it, you need it, you take it. You don t take a whole lot, just what you need, eat as much as you can when you can, drink as much as you can when you can, because you don t know when you will get any more. After that we moved on to evacuate patients from the Superdome and take them to the triage station at the I-10, and this was probably the worst scene I saw the whole time. It was five days post-hurricane, and people were in really bad shape. The 21

22 people that were going to die had died. The people that will die, were dying. The smell was just unbelievable. People crying out for help, and there were a lot of people that were psychiatric cases. It was unbelievable. You always see this kind of stuff on TV, so you don t really think that something like this could happen in your own world. We got all those patients moving and this is the biggest thing FEMA is so bureaucratic! You got to get names, got to get this and that, and these patients are dying right dead in front of you, but FEMA wants all these little things. We didn't have time for all this bureaucracy. I came back home because we ceased air operations during the day, and I got a good shower and slept in my bed. Did not sleep really well because I was still spun up, and woke up real early the next morning and went straight to the communications center, packed a bag and went back out to the airport and did it all over again. Stayed there most of the day and turned over patients real rapidly. Dr. Ricardo Martinez had lots of connections and he was great, and even if he did not have many connections, he was very well motivated. You know, my military roots come to play here. I kind of call it like a forward air controller. I just kind of got on scene and figured what we had, where they were going, how much resources we needed, and how long we were going to be there. We just went rooftop to rooftop to rooftop for eight or nine days. Dr. Ross Judice, Medical Director At one point while I was at the Superdome helipad coordinating the evacuation of patients from the Arena, some military trucks showed up with orders to bring the vent-dependent patients from the VA Hospital being bagged over to the Dome to have them flown out from there. Because they were most critical, we temporarily halted the evacuation of the DMAT patients. The PHI helicopters took the first four patients, one at a time (they only are configured to carry one patient), and we had no way to evac the last two because the pilots had maxed out their hours and couldn t fly anymore. I remembered that I d seen some National Guard Blackhawks flying in and out with supplies earlier, so I went over to where they were stationed and asked them to fly these last two patients out. The guy said, in a snotty way, Yeah, we ve been watching you fly them out on those PHI helicopters. I was shocked that he d just been sitting there watching us move the patients one at a time when those Blackhawks could have taken them all in two trips. I didn t want them to know how angry I felt, 22

23 because I really needed them to fly these bagged patients out, so I asked him nicely and he agreed, but he complained the whole way. That was Tuesday night. Later on it got quiet in terms of flights, and I went into the Dome to be a doctor again, thankful to be doing what I know best instead of directing evacuation operations from the helipad, which is what I d been doing for the last 12 hours. Wednesday morning, to our great relief, a zillion helicopters showed up, all types, civilians, military, Coast Guard, and National Guard. It was probably the largest air medical evacuation ever within U.S. borders. That s when things started getting really chaotic, because more people were getting sicker and sicker in the Dome...people without their meds, babies being born, dehydration, strokes, you name it. We d load people onto a Blackhawk, it would lift off, and the a civilian helicopter would land, we d load it up, it would lift off, then a Coast Guard helicopter...it went on and on like this for hours, all day Wednesday into the early evening. We d shove people into those helicopters so fast that our communication system just fell apart, there was no taking names, no paperwork, nothing, just throwing people into helicopters and getting them out of there. There just wasn t time. I remember writing down the names of the first three patients on the PHI helicopters, but after that, there was no way. There just wasn t time. I had one guy who d had a stroke in the Dome, and he had a large extended family with him. I put him on a helicopter, which has no room for extra people. The family flipped out because they couldn t go with him, and I had to call the MP's to push them away. We couldn't even tell them where their daddy was going. Most of these patients were being dropped off at the I-10 cloverleaf to be put into ambulances and taken to various locations, but we had no idea where those locations might be. And plans changed all the time. Even if they went to a particular hospital, they d often be transferred, so families were always being separated, and this happened to hundreds, maybe thousands of families. Remi Judice, Nurse Anesthetist On Wednesday at the Superdome, helicopters would come in groups. In a 45- minute span you might get 10 or 15 helicopters landing. Then at other times, we d have long dead periods where we wouldn t see a helicopter for 30 minutes. If we weren t careful we could have a whole bunch of sick people in our staging area near the helipad in the middle of a hot summer day, and have to treat them when we didn t have many supplies and no way to evacuate them. I was frustrated when 23

24 there were no helicopters coming in, and walk over to the heliport and say, Do you know if any helicopters are coming? And the guy would say, We have 2 getting ready to land. Get your patients ready." And I d say, When? And he d say In the next 15 minutes. Get em down here." So we d get em down there but the helicopters wouldn t land for another hour. So we d have sick people just sitting there waiting in the hot sun with one little tent over them. Then finally a helicopter would come, but would only take certain patients. They'd say, We want eight people that can walk. Well, those aren t the sickest people, the sickest people are the ones that can't walk...they're on the stretchers, and at some point there were National Guard and civilian helicopters that wouldn t take any stretcher patients. Somewhere between 3 and 10 p.m. there were helicopters coming in, and we couldn t fill them fast enough. They were anxious to land and leave, for one reason probably fuel, and another reason they probably had other missions to do. There were obviously two different agendas for the helicopters...one was to evacuate patients and the other was to transport supplies. I was just involved with the evacuations. At one point I called the DMAT area to bring out some patients for evacuation, and we were able to evacuate everybody. It was a race against time to get patients from DMAT to the helicopters. The DMAT person would tell me he had two walking wounded and one stretcher, and I'd say, I don t care what they are, I want as many people as you can send. And he would say, I found two more stretcher patients, and we re sending you six walking wounded. And I'd say, Send em all. I wanted to make sure no helicopter was left unfilled. We were putting people into helicopters as fast as we could, not writing down their names or knowing where they were going. After a while it slowed down to a crawl, and eventually in the late evening around 9 p.m. there were no more helicopters flying and we just took care of patients in the dark. 24