BY MIKE OLINGER, MD
I was deployed for 10 days with the Blue Incident Support Team (IST) in Shreveport, Louisiana. The IST, deployed whenever a task force is deployed, is an overhead team that serves as a liaison between US&R resources, the local community, and other federal assets engaged in the incident. The team is responsible for overall incident planning and coordinating task force operations at the incident. As chief medical officer, I establish liaisons with the local medical community and developed an Incident Medical Action Plan.
The Blue IST, along with Tennessee Task Force-1, Missouri Task Force-1, and Texas Task Force-1, was activated on August 25. We were to report to Shreveport, Louisiana, by noon on Sunday, August 28.
I met with other activated team members in Shreveport on Sunday morning, August 28. We stayed in a Holiday Inn Express not far from downtown and developed plans for our deployment.
Katrina was a strong Category 4 hurricane and was expected to reach Category 5 before it made landfall. Mandatory evacuation had been ordered for New Orleans, and the hotel was filling with people who had evacuated the Gulf Coast. On Monday morning, August 29, we watched the hurricane make landfall on television. It had veered to the east, avoiding a direct blow to New Orleans. We speculated that the damage would not be too great and that we would be home within a few days.
At 1000 hours, I left with the advance team for New Orleans. We stopped by the State Emergency Operations Center (EOC) in Baton Rouge that evening. The two light (Type 3) US&R Task Forces (TN, MO) and the full (Type 1) Task Force (TX) met us there; we went by convoy into New Orleans Monday night under State Police escort. We arrived in New Orleans about midnight.
We set up in the parking lot of a Sam’s Club in East Jefferson Parish. I was amazed at how dark it was. The sky was clear, and I could see the Milky Way just a few miles from downtown New Orleans. We got a few hours of sleep in our rental cars.
NEW ORLEANS BOAT EVACUATIONS
Early Tuesday morning, August 30, we commenced rescue operations from a site where Interstate I-10 and I-610 split on the west side of the city. There, we entered the flood waters in boats provided by the Louisiana Department of Wildlife and Fisheries.
It was a hot day, 95° with bright sunlight. Many people had gone into their attics as the water rose in the lower levels of their houses and were trapped there. Stronger individuals were able to break their way out onto the roofs, but many of the elderly remained trapped in attics, where the temperature had to be well over 100° in the bright sun and hot sticky air.
The first day, we rescued 339 individuals; a few of them were quite ill and suffering from conditions such as decompensated congested heart failure (CHF), dehydration, and exposure.
That first day, we could not get any ambulances to transport, so the sicker evacuees were taken in the back of pickup trucks or in staff cars to Ochsner Clinic, the one local hospital that was accepting new patients. It was a level-two trauma center that had survived Katrina relatively intact.
East Jefferson Parish Hospital was running on generator power. Although the building itself was dry, it was surrounded by water and accessible only by boat or jet ski. The staff was sleeping in the hospital, which was in disaster mode.
When I met with the chief executive officer Wednesday morning, August 31, he asked that we not bring any patients to their facility. The same medical staff had been caring for patients around the clock since Sunday evening. Hospital staff members who were not on duty when the hurricane hit had evacuated, and they could not get back into the city.
East Jefferson Parish EMS, the hospital-based EMS provider, had parked all of its ambulances on the second floor of the parking garage the night before the storm. The ambulances were intact, but they could not get out of the flooded parking garage. Crews were responding to emergency calls in U.S. Army ¾ -ton trucks. The 911 system was down. To get an ambulance (truck), you had to call the seven-digit number for the Parish’s EOC, which would dispatch a vehicle.
The number of boats in the water limited our rescues on the first day. We had 28 boats from the Department of Wildlife and Fisheries. The boats made repeated trips into the neighborhoods. When filled to capacity with four to five evacuees, the boat would return to the launch site to unload and then go back out.
As each evacuee made his way from the water, a Coast Guard crew stationed on the ramp recorded the name and address. We completed operations at about 1930 hours and returned to the Sam’s Club parking lot. Several more US&R task forces were responding to New Orleans, and the parking lot at Sam’s was too small to accommodate the resources coming in. We packed and moved to the New Orleans Saints training facility and the adjoining Zephyrs Field, the stadium for the local AAA baseball team, which became the base of operations (BoO) for all federal resources responding to New Orleans.
We finished unloading equipment from the IST trucks at about 2300 hours and tried to get a few hours of sleep before our 0700 hour briefing. There was no electricity, no running water, no air-conditioning, and no showers or toilets. At 2300 hours, the temperature was still over 80°, and our clothes were soaked in sweat. We used gallon jugs of water given to us by Sam’s Club loss prevention officer to take makeshift showers in the parking lot. I spent another night sleeping in the car, but at least it was air-conditioned.
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The next day, Wednesday, September 1, we went back to our work site. We were met by a line of vehicles with boat trailers stretching at least a mile down I-10 (photo 1). Most of these volunteers were from sheriff’s departments from all across southern Louisiana and East Texas or civilian volunteers. Scores, if not hundreds, of boats were entering the water at the I-10/I-610 split (photo 2), and it was estimated that more than 2,000 individuals were evacuated from the site that day. At times, more than 300 people per hour were being brought ashore. There were no attempts to get names or otherwise track these individuals.
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FORWARD TREATMENT CENTER ESTABLISHED
On Wednesday, we were told that neither hospital was taking patients. The city’s plan for anyone needing acute medical care was to transport them to an assembly point on I-10 and the Causeway. There, they would be triaged to go by ground or air to Baton Rouge, where three disaster medical assistance teams (DMATs) had been set up. Since literally thousands of people were waiting at the I-10 and Causeway collection point for transportation to Baton Rouge, we were not comfortable with that option.
Using the medical cache from the Texas Type 1 Task Force, we established a forward treatment center to support the US&R operations. The more critically ill people rescued by US&R resources were first stabilized by US&R physicians while arrangements for air evacuation were made.
OPERATIONS HALTED
We awoke Thursday, September 2, to a gray day with intermittent light rain. Two more task forces (Florida 1, New Mexico) and eight California swiftwater rescue teams joined us along with about 800 active-duty troops, including the U.S. Army Reserves and the U.S. Coast Guard. The Arizona Task Force and the Colorado Task Force, which had also been deployed, were to arrive the next day.
As we were preparing to leave for rescue operations, we were halted by a directive that said that all federal rescue operations were suspended because of civil unrest and that we were to withdraw from New Orleans. We had never felt threatened at our BoO (the New Orleans Saint’s training camp/Zephyr Field) or during our rescue operations. We were allowed to remain in place. Extra security was brought in, and a security checkpoint was established at the entrance to the BoO. No one could enter the compound without a federal ID.
OPERATIONS RESUMED
On Friday, September 3, operations resumed. As civilian volunteers and sheriff boat crews were heavily searching the flooded areas accessible from the I-10/I-610 split, we moved our operations to an area northeast of the city that had a high residential density and had not been searched. We were able to get four ambulances from East Jefferson Parish EMS and two from Acadian Ambulance Service, a large private ambulance company serving East Texas and Louisiana.
Receding floodwaters had allowed East Jefferson Parish EMS to retrieve its ambulances from the flooded parking garage. They were able to provide the staffed ambulances because most of the population of their parish had evacuated and the call volume was quite low.
We used the ambulances to transport ill or injured evacuees from the several access points from which the US&R teams were operating to the forward treatment center we established. We also obtained the use of three 2½ -ton trucks (deuce-and-a-halves) from the Army National Guard to transport the rescued to a collection point for further evacuation by civilian and military rotorcraft.
Acadian Ambulance’s Medical Director, Dr. Ross Judice, joined us at the BoO to coordinate air evacuation for victims rescued by the US&R rescue teams who needed emergency medical treatment. Our communications team had set up three repeaters; we had fairly good communications across our large area of operations.
We learned that a DMAT had been set up at the New Orleans Airport and would care for all of the rescued who needed acute medical care.
Rescue operations began by midmorning. One of the search teams came across a two-story Catholic nursing home. It never actually flooded. As the flood waters began to rise, the nun and remaining LPN had managed to evacuate the residents from the ground floor to the second floor using sheets and blankets to pull them up the stairs. They had stayed and cared for these patients to the best of their ability for four and a half days with no electricity, no air-conditioning, and a limited supply of drinkable water. Fifteen of the residents had died, and the 59 survivors were severely dehydrated. The task force evacuated them to a landing zone (LZ) set up along US-90. We were able to get U.S. Army Black-Hawks and a Chinook to fly them to the airport for treatment by the DMATs (photo 3). As the helicopters landed and took off, rescue personnel shielded these frail victims from the rotowash with their own bodies.
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Because of the large number of people being evacuated from this area, operations were extended until sunset. Florida Task Force-1 had rescued 32 people and brought them out of the flooded area after air operations for picking up the rescued had been suspended for the day. Twelve people were in wheelchairs; all were fairly elderly and frail. They were placed in the back of two of the deuce-and-a-halves and went in a small convoy, with Deputy Operations Chief Mike Brown, to the airport.
TURNED AWAY FROM AIRPORT
At about 2130 hours, I was called to meet with Brown at the gate to the BoO. He reported that when the deuce-and-a-halves arrived at the airport, the local police told them the airport was closed to “refugees” and that only patients could be taken into the airport. Brown tried to explain that 12 of the evacuees were wheelchair-bound; he was told that they were not patients and would not be allowed into the airport. When one of the truck drivers tried to radio the BoO for instructions, a shotgun was pointed through his window, and an angry officer yelled, “Boy, you don’t *&*&*% understand! Either you turn that *&*&*% truck around right now, or you are arrested!” The drivers turned the trucks around and drove back to the BoO, where they were denied entry because the evacuees did not have federal IDs.
While I was out meeting with the deputy operations chief, my deputy medical officer, Ken Miller, called the DMAT commander at the airport and was assured that this was a misunderstanding and that they, not the police, decided who would get medical treatment. The police were there for security, not triage. The commander said they would take these patients and care for them and that we should bring them back to the airport.
Having had a shotgun pointed at one of our truck drivers and having been yelled at by the police, Brown was not willing to return to the airport. We got the phone number of the DMAT commander so we could talk to him directly. Brown called him and was assured that this was all a misunderstanding and that he personally would meet us at the gate and escort us in. We turned the trucks around and headed back toward the airport. I rode with Brown in the back of a pickup truck.
We were stopped at the gate, but after a brief conversation with the guards, we were allowed to enter the airport. Just as we approached the ramp to the departing passenger area, three squad cars surrounded our small convoy, and police officers with M-16s and shotguns jumped out of the cars. Brown and I went over to the one who seemed to be in charge. He began screaming, “I know you! I know you! You and I have talked before!”
The DMAT commander stood there in awe. A nurse was with him. As Brown tried to explain to the officer what had transpired, I asked the nurse if she knew of a place where we could take these people. She told me that a hospital on the other side of Baton Rouge was taking patients. It was 2230 hours. There was no way we were going to drive these people two hours to Baton Rouge, which was bursting at the seams with evacuees, to a hospital that may or may not take them.
I told her we were going to take them to the evacuee collection point at I-10 and the Causeway. She became upset and started to cry. “You can’t take them there; they will die,” she sobbed.
Meanwhile, having been quite unsuccessful in explaining to the police the circumstances that brought us back to the airport, Brown had agreed to again turn the trucks around. As the second truck turned to leave the airport, the police officer who had been screaming obscenities at us saw the people in wheelchairs in the back of the truck. He stopped the truck and told the driver he could unload that truck. I went over to him and asked if we could at least unload the people in wheelchairs off the first truck. He eventually conceded; we could unload both trucks. We drove up the ramp to the departing-passenger/ticket counter area of the terminal and unloaded our evacuees to the curb (photo 4).
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I went into the terminal to give a report and found wall-to-wall people, some sleeping on the floor and some standing in what appeared to be a line that disappeared into a sea of humanity (photo 5). I could find no one who appeared to be in charge or any sign that there was some organizational structure to this mass. It was into this chaos that we released our evacuees.
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By Saturday, September 3, our BoO was filled to capacity. We had a little more than 500 US&R personnel and about 1,200 active-duty military and reserve troops in addition to the other federal resources joining the operations, including the Environmental Protection Agency, the U.S. Geological Survey, the Army Corps of Engineers, and Public Health Service. All of us were living in the area comprised of the Saints training camp and Zephyr Field. Despite repeated attempts since early Tuesday morning, logistics were still unsuccessful in acquiring portable toilets, hand-washing stations, and showers. Sanitation and hygiene were becoming major issues.
The IST had by default become responsible for all of these personnel. We contracted for 2,500 meals to feed the people living in this area on Friday night and ran out of food before all of the US&R rescue teams had returned from their missions.
By Sunday evening, September 4, electricity and air-conditioning were restored to most of the compound. Portable shower trailers with potable water had been brought in along with portable toilets and hand-washing stations. We took showers for the first time Sunday night. We didn’t have the propane to heat the water, but cold showers were refreshing if not totally satisfying,
On Saturday and Sunday, we concentrated our search and rescue operations to the residential areas within the city. By the end of the first week, we had completed thousands of rescues and conducted a hasty search of essentially all flooded areas of Jefferson Parish and Orleans Parish.
By Monday evening, September 5, we had rescued essentially everyone who wanted to leave.
RECOVERY OPERATION
On Tuesday, September 6, the IST began to plan for a prolonged recovery operation during which every building within the impact zone would undergo a primary and secondary search and bodies would be extricated to a disaster mortuary operational response team (DMORT). I demobilized back to Indy.
This was the first time I worked in an environment with no infrastructure-no electricity or running water, cell phones didn’t work, and satellite phones worked sporadically. There was no EMS system to transport patients or hospitals to transport them to.
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On the Monday before I left, I went to the New Orleans Airport to meet the DMATs deployed there. The airport was a ghost town (photo 6). Over the weekend, the Air Force had brought in scores of transport planes and evacuated all of the evacuees to cities across the United States. The DMATs were still set up, and a physician from the Pennsylvania DMAT showed us around and told an amazing story. They had traveled all night and arrived at the airport at 0900 hours. They set up their treatment tents in one of the terminals and opened for patients at 1100 hours. That first day they saw more than 2,000 patients. They were so overwhelmed that their triage algorithm was anyone needing more than 10 to 15 minutes of medical care was triaged as black. They set up an expectant ward on one of the departure gates for these patients and staffed it with a nurse and some morphine. Some of those triaged as black took up to two days to die. It was then that I realized that the nursing home patients we had proudly “rescued” on Friday were probably among those black-tagged to die at the gate.
MIKE OLINGER, MD, has been medical director of FEMA’s US&R Indiana Task Force-1 since its inception in 1991 and of FEMA’s Blue IST team. He was deployed as IST chief medical officer to the Oklahoma City Bombing, the DeBruce Grain Elevator Explosion, the Summer and Winter Olympic Games held in Atlanta and Salt Lake City respectively, the World Trade Center, the 2004 Republican National Convention, and Hurricane Katrina.
