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JEMS
11/21/2005

FEMA Tennessee Task Force One Urban Search & Rescue

A Medical Specialist Perspective

By J. Harold Logan, EMT-P

Like the most gracious Southern hostess, New Orleans welcomes visitors with a genuine hospitality and singular flair. My wife and I took a long weekend in April of this year and took in what this carefree city had to offer. During the day, we strolled the streets of the French Quarter. This section of New Orleans is most unique. A city within the city with European flair and relaxing carefree atmosphere by day and adventurous nightlife by the light of the moon on Old Man River.

New Orleans is just about anything you can imagine and many more things you can’t. Wild and unbridled or relaxed and subdued. The nights in New Orleans are always unforgettable. When the sun goes down, New Orleans comes alive with a magical energy all its own. New Orleans’ nightlife is legendary—a diverse offering full of music, color, flavor, fun, and excitement and romance. This city never sleeps ... or so we thought.

The neon lights, noise and the revelry of Bourbon Street would all end four months after my romantic weekend with my wife.

A hurricane by the name of Katrina came ashore on the Gulf Coast on Aug. 25, 2005.

The Mayor of the Crescent City gave the order for a mandatory evacuation of the citizens as the storm approached. Many jammed the hurricane evacuation routes, but many stayed, unable to leave for many reasons; no car, no money for gas or other transportation. Many were elderly or ill and could not evacuate, and many kept the carefree attitude and decided to “ride out the storm” like so many times before. Many took the ride of their life.

My next visit to the “The Big Easy” would be all business, as a medical specialist with Tennessee Task Force One. This team is one of 28 FEMA USAR teams located across the United States. We have been deployed to numerous missions in our 10 years of existence, including the Pentagon on 9/11/01, the Space Shuttle disaster and various hurricane deployments.

To say FEMA is not ready to respond to a major incident is a fallacy when it comes to urban search and rescue. We are usually deployed two days prior to landfall in cases like Katrina. This is the beauty of storm prediction and hurricane recon. So the story for FEMA was the same for this storm. As Hurricane Katrina made its way into the Gulf of Mexico we made ready for hurricane duty for the sixth time within a 24-month period.

As the storm gained strength and slowed its speed of travel, we were on the road as a type III USAR team, consisting of 34 members from different disciplines: medical, technical search, rescue, K-9, structural specialist and others.

A type III USAR team is utilized for fast response and rapid reconnaissance, search and rescue. The medical team referred to by FEMA as Medical Specialist, comprises MDs, RNs and paramedics with extensive critical care experience combined with additional training and experience in the search-and-rescue disciplines.

FEMA dispatched two other USAR teams along with us: Missouri Task Force One and Texas Task Force One. MO-TF-1 was sent out as a type III team and TX-TF-1 as a type 1 team. A type I team is a full task force team with 72 members and a full cache of equipment and supplies to self-sustain for up to 72 hours. Other FEMA USAR teams had been deployed from the Eastern Seaboard and the state of Florida for insertion into the affected areas of Mississippi from the East.

Aug. 28
We arrived at our hotel around 5 a.m. on Sunday morning Aug. 28, 2005. We had traveled west from Memphis through Arkansas, down the western edge of Louisiana to the city of Shreveport, La. If you’re looking at a map, this route seems a bit bizarre. The quickest route from Memphis to New Orleans is almost a straight shot down Interstate 55. However, the safest route was to come in from the West and wait as the storm made landfall and tracked across the states of Louisiana and Mississippi. We would come in behind the storm.

We watched the reports as they came in. Some of our team members weren’t sure how the storm would play out. We had been sent out the door on deployments several times in the past just to be turned around three or four days later with no services rendered. In FEMA’s defense, it is common practice to have teams sent into an area, but out of harm’s way, and position them for rapid insertion into the affected area. For example, our team had been deployed to a Naval Air Station close to the expected landfall of Hurricane Dennis. The storm came ashore and, with luck on the side of the citizens of Mobile, Ala., it vaporized into just a bad thunderstorm with minor wind and rain damage.

Monday, Aug. 29
FEMA moved us to a staging area in Baton Rouge after the storm moved through. As we arrived, Katrina was still wreaking havoc on the Gulf Coast. Baton Rouge had also taken a hit. Utilities and trees were down, and there was other evidence of storm damage.

The rally point for the initial USAR teams was the LSU Fire Academy. During a short stay at the Academy, our task force leaders and members of the incident support team from FEMA had an opportunity to formulate strategies and tactics.

A convoy of three FEMA USAR teams made its way to the dark, desperate city of New Orleans. As we made our way by escort to East Jefferson Parish and the suburban areas of New Orleans, we saw what the cable news networks and the Weather Channel had not yet captured. We knew we were going to be here a long time. The damage was extensive even though we were hearing that the area had escaped the “worst” of the storm. I have since learned the true meaning of a relative term.

As we entered the city, we were faced with road blockages, unmitigated house fires and looters. We had to halt our convoy and stage in a “secure” area while the state police chased looters who had taken merchandise and shot at the police.

The convoy moved to a parking lot of a SAMS Warehouse store. We slept on the hot pavement and in the back of trucks. No one complained; at least we had a place to go home to. In the early morning, one of the guys awoke to an elderly gentleman standing over him. In broken English and hand motions, the man was trying to explain his situation. We figured out that he was retuning home from a local hospital where he worked as a janitor.

The man kept saying “Whoosh” and moving his hands over his head and waving them. He did this several times, occasionally pointing to the ground and making a circle on the pavement before him. We finally understood what he was trying to say. The elderly man had been walking for several hours trying to get home after his car flooded out at the hospital. He only wished to tell his story, get washed up and have a drink of clean water. We assessed him and respected his wishes, leaving him with the a local police officer.

Tuesday, Aug. 30
As we rested in the early morning of Aug. 30, we were still unaware of the amount of devastation the New Orleans area and Gulf Coast had received. Little were we aware that we were on the eve on the largest rescue mission of the largest natural disaster recorded in the United States of America.

The first day of operations was organized chaos. We moved to our mission area of I-10 and I-610. The interstate had been turned into a giant boat ramp. The levees had broken shortly after the hurricane made landfall, and now 80% of the city was under water.

People began to arrive in droves. Search-and-rescue teams were finding people on rooftops, in attics, standing on autos, fences and second-story landings. Wherever it was humanly possible to get out of the water—there they were. The boats came, and came. Many of the people arriving were elderly, sick, hot and tired. Some were young and orphaned by the storm. Some with heartbreaking stories of family members lost, such as Judy Martin who told of watching her 94-year-old mother drown because she was unable to physically get to the higher area of the house.

It was announced by radio that this was not a “normal” search-and-rescue operation. FEMA USAR teams are devised to handle such situations as the Oklahoma City bombing, the first World Trade Center bombing, the 9/11 attacks on New York and Washington, D.C. No one had ever been thrust into this type of environment (massive water rescue) in the history of FEMA urban search and rescue. Most of the book was thrown out the window, and we were writing new chapters.

The chatter on the radio stated that search-and-rescue operations were going just fine. However, while these operations were going great, the problem was that, once the victims were brought out from the peril of their flooded/hurricane damaged homes, there was no initial plan for where they should go. Some were exhausted from holding onto what ever they could to stay above water. Some had chronic conditions and hadn’t taken their medication or eaten in more than 24 hours. And some were out of their home oxygen.

Other survivors were just emotionally drained. Many just needed a moment of kindness, simple guidance as to where they should go and a little TLC. Dr. Ken Miller from FEMA’s incident support team transmitted to Operations that this situation had turned into a humanitarian and medical mission and that the focus must be turned in that direction.

As this was relayed to operations, Joe Holley, MD, Medical Team Manager for Tennessee Task Force One, Chris Bouche, MD, Medical Team Manager for Missouri Task Force One and myself began to establish an MCI format for proper triage, treatment and transport of victims. Triage had already begun at the water edge by other members of our team just prior to our arrival, with most being tagged green.

We had limited resources. Extra hands weren’t available due to the magnitude of the disaster. Extra supplies weren’t on hand. The medical aspect of USAR teams is primarily configured to render care to members of the team, and then victims as encountered. Well, when the authors of the FEMA Field Operations Guide wrote the manual, I don’t think they envisioned the rescue, triage, treatment and transport of 368 victims on the first day of operations during the aftermath of a hurricane. Tennessee Task Force One and Missouri Task Force One combined their efforts and facilitated the rescues and established triage, treatment, and transport of those 368 people on the first day of operations in New Orleans.

Without the green, yellow and red tarps, without START triage tags or color-coded ribbons and initially without any ambulances, we made it happen. We utilized a modified START triage system and found it to work very well. Keep in mind we did not have many tags with us and could not stop and ask for an order of START tags while the victims were taken off the boats.

We had contacted the medical director from a local ambulance service and were told it would be about four hours before we could get any means of transportation. However, on the way to the scene, I had noticed about 30 ambulances staged around the now famous overpass where evacuees gathered for transport out of the city. Each ambulance had a driver and an attendant seated in the front. I found this odd. As I passed them there was no activity—just staged ambulances. Ill and injured people were being brought in by boat while these ambulances were idly staged.

We pulled one woman from a John Boat. She was lethargic, cool and clammy, and having difficulty breathing. She was a diabetic and suffered from COPD. She hadn’t eaten or taken her meds and was out of her home oxygen when the crew transporting her found her. They had pulled her from an attic. The attic vent in the gable was breached with a chainsaw and other tools. The rescue was made more difficult by the patient’s estimated weight of 350 lbs. Now, she had made it to land but we still had no transportation. What now?

Remember this is at a point at the initial stage of an MCI where folks on the ground are used to local assets being in place on their arrival. But this day, all local assists were committed—used up. So we placed this first patient in the back of one of the pick-up trucks that had just put a boat in the water and headed toward the only means of EMS transport I had seen that morning, at the end of the Interstate. Treatment had begun during the boat ride from the patient’s house to the interstate ramp. Dr. Bouchi and I made the trip with the patient who was now becoming more obtunded.

We approached the last of the idle ambulances and informed them of our patient. The paramedic directed us to the first ambulance in the long line of about 30. Remember that these ambulances weren’t being utilized and had been sitting stationary for four hours. In future days, this area would become quite busy and would receive much media attention as one of the main evacuation points in the city. But, for now, it was idle.

We were told that these ambulances were committed to this area and they could not take our patient. Someone mumbled something about honoring a contract with a hospital and evacuation of the Superdome.

At this point frustration set in on my part and I passionately explained what was happening two miles down the road while these trained men and women sat in their air-conditioned units. I expressed our situation to a supervisor of the service. I guess it sank in, because we were then directed to an ambulance and our patient was then transported to a hospital facility. That supervisor made it happen for us, moving some of his resources in our direction. Communication is often the weakest link at scenes like this.

But the patients kept coming. Two guys with Advantage Ambulance Service were a tremendous asset to our operation—shuttling our patients to the larger transport area established by Acadian Ambulance Service.

Wednesday, Aug. 31, 2005
The next day was much of the same. They continued to come—ill, dehydrated, emotionally drained. The triage, treatment and transport areas were now more established and fine tuned. Coast Guard helicopters now landed between our triage and treatment areas on the interstate to off-load patients into our care. Agencies were communicating and things were working like a well-oiled machine.

More focus was given to treatment of the patients on this day. The patients were sicker, and dehydration was now a major factor. While moving two intoxicated victims—yes even here in this situation—to the transport area for non-emergency transport by public transportation, Dr. Bouchi and I were redirected in the treatment area. A patient that had just come into the treatment area from triage had collapsed and FEMA USAR had the only ALS assets at this site. The woman had gone from green to red priority in five minutes.

We left the intoxicated couple with the driver of the pick-up that brought him to us and Dr. Bouchi and I began to treat the patient that had collapsed. She was bradycardic and had agonal respirations of four per minute. After intubation, adequate oxygenation, and a fluid bolus, her heart rate improved and she was ready for transport.

The primary problems we saw were related to the heat and dehydration. The heat index was between 100 and 105 degrees. Patients requiring treatment on Aug. 31 include one of our own, who was overcome by the severe heat. One of the structural engineers with us also developed heat exhaustion. We treated him on scene with fluid replacement and monitored him on site because there was no place to send him that had more capabilities to treat than we had. The hospitals in the area were severely overwhelmed.

The local EMS agency in East Jefferson Parrish brought us a mobile care clinic and said we could use it for what ever we needed. The large RV served as the base of operations medical treatment area for the 17 USAR teams that had assembled just outside of New Orleans. Tennessee Task Force One Medical Team served as the primary means of medical care for a camp that now was exceeding 2,000 men and women.

As with all deployments, we performed a lot of foot care. We treated minor skin infections with wound dressing and antibiotics and were also called on to treat plenty of minor injuries, some requiring sutures.

To the west of our location was a different story. DMAT had set up shop at the New Orleans International Airport. Guys we talked to that had brought patients there said the dead and dying were everywhere. Everyone in New Orleans was overwhelmed.

Thursday, Sept. 1, 2005
Awake at 5 a.m., our mission was to be the same as the two days prior. We loaded into our vans and, as we were pulling out of the parking lot of the FEMA USAR base of operations located at the New Orleans Saints NFL Training Facility, we were told via radio to “stand down.” Rescues for the day were cancelled due to increased violence in the area. Apparently, there had been shots fired at civilian rescuers and reports of boats being turned over during scuffles among citizens trying to get to dry land.

One report had one individual cutting another with a knife while fighting over a place in the boat. Innocent people died that day indirectly at the hands of those who decided to riot, loot and shoot at those who came to help. FEMA decided they could not allow us into these hostile areas without force protection.

The national guard and federal troops were on there way. However, when they did arrive, they were busy with evacuation efforts of the thousands at the Superdome and the New Orleans Convention Center.

God bless the men and women of the New Orleans Police Department that stayed. A third of their force had turned in their badges and left town. The ones who were left provided for our safety for the remainder of our time in the “Big Easy.”

One of the officers assigned to us for our protection had sent his wife and unborn child out of harm’s way the day before the hurricane. It had been four days since he talked to her. There was no way to communicate with the outside world.

On Tuesday, a reporter from People magazine received word from someone that the officer’s baby was born and notified him that mother and baby were fine. It was a boy. The first-time father had not seen his new child, so, because he had protected us that day, some of the guys decided to track down the reporter and have him e-mail photos. The new dad had something to put in his wallet and show off the next day.

The officers told us that the day before, some convoys took fire as they left the scene. So, at the end of the day, our force protection positioned themselves in makeshift sniper’s nests as we prepared to leave in convoy.

Friday, Sept. 2
Today, we reached a nursing home, staffed by a Catholic nun, an LPN and three aides. They had carried their 85 patients to the second floor as the water rose to seven feet in a just a few hours. Trapped there for four days, they had cared for the patients in the hallway on the second floor.

All of their patients requires complete care, essentially bed-bound. Many were severely demented, PEG tube fed, contracted and in diapers. These brave caretakers had kept 57 residents alive for nearly a week with spoiling food and limited water. These caregivers had their resourceful instincts pushed to the limit, using the vinyl mattress covers for body bags.

On our arrival, Dr. Holley assessed each patient and began the difficult process of triage. With the help of the caretakers, patients were organized for evacuation. Resources were very scarce for such a high level of care, and several more of the most infirm would die before we were able to evacuate them. Ultimately, all were evacuated, along with their caretakers.

As this life-and-death scenario played out, Texas Task Force One was extracting residents from their home just three or four blocks down the street, in the Wilson and Chef Menteur area. TN-TF 1 Medical Specialist Lynn Thompson who, along with Dr Holley, had been assigned with the Texas team for the day, provided a much-needed human factor. They gave water and food to those in need, a kind touch and took the time to listen to each person’s story of their ordeals and losses.

Even though we were in what was considered a hostile area, no threats or incidents of violence were directed at our team. All the contacts made that day were presented us with praises of gratitude and genuine thanks for our assistance.

The rest of our time in the region was spent much the same as the time in New Orleans, with force protection continuing. But our means of transportation changed. We were inserted by Blackhawk helicopters to hostile areas surrounded by water. The lawlessness continued, but so did the rescues. It truly felt like we were performing rescue missions and caring for the sick and injured in a combat zone as we landed in what had been the battle field of Chalmett where another war was fought in 1812.

We not only had to remain concerned about the violence, but also the unseen toxins and pollutants in the area. Many oil refineries around Chalmette had leaked crude oil, as well as toxic chemicals such as benzene and toluene. The tree line between us and the refinery had already turned brown, and between the toxins and decontamination process we followed, the dye in our boots began to disappear. We’ll be carefully following the team for signs of problems in the future.

After 10 days, we were rotated out of New Orleans. The team was physically exhausted, but emotionally ready to continue. Physical conditions were harsh, but the psychological toll was not as bad as our 2001 Pentagon deployment. As I write this, some 6,500 persons have been rescued and cared for by FEMA Urban Search and Rescue in the New Orleans area.

About the Author
J. Harold Logan, EMT-P is medical coordinator of FEMA Tennessee Task Force One. He was assisted in the preparation of this article by: Joseph Holley, MD. Medical Team Manager TNTF-1 and James L. Thompson, RN, EMT-P Medical Specialist TNTF-1

JEMS
Back to the main Katrina map page.
This is the most amazing magazine which details from an EMS point of view, the happenings of Katrina. It is called JEMS (Journal of Emergency Medical Services). Most of the links here have been taken down but you can still visit their site for more stories at www.jems.com.
Living Nightmare by Courtney McCain, EMT-P
Shelter from the Storm by Valarie Ziminsky, EMT-P
FEMA Tennessee Task Force One Urban Search & Rescue by J. Harold Logan, EMT-P
Chaos of Katrina: EMS maintains composure in the midst of anarchy by Ann-Marie Lindstrom and Keri Losavio
Behind Katrina's Eye with New Orleans EMS
When Rules Change by A.J. Heightman, MPA, EMT-P from JEMS Journal, November 2005
In the aftermath of Katrina
Riding out the Surge - (pdf file 258kb) - Page 42 of JEMS Journal, November 2005
Build It & They Will Come (pdf file 213kb) - Page 50 of JEMS Journal, November 2005
JEMS pictures (pdf file 2.1mb) - Page 12 and 13 of JEMS Journal, November 2005
Text articles: The Big Picture; Flying into the Storm; Stranded Providers Pitch in to help.
PDF (3.3mb) of the same text articles with pictures from JEMS Journal, November 2005.