Upon reflection, most medics who worked in New Orleans during Hurricane Katrina are able to recall a mixture of fragmented and vivid memories 18 years later. The smells. The sights. The sounds. The darkness. The isolation. The heat. The death. The comradery. The joy of a water bottle shower. Most of all, the need for survival by any means necessary to continue to help those in need despite their own personal loss.
I was activated at our unit in Belle Chasse to work EOC to dispatch missions during Hurricane Katrina. A few days prior to landfall, I remember our military unit assembled shoulder to shoulder for a commander brief preparing us for a statewide activation. The usual missions were underway, secretly hoping for another narrow escape for the city. Little did we know how our lives, landscape, and culture would forever change.
I spoke with several EMS providers who were instrumental to Hurricane Katrina response efforts, who shared 3 primary lessons from the disaster response.
1. Be prepared for multiple contingencies
An estimated population of 150,000 to 200,000 remained in the New Orleans metropolitan area during Katrina landfall.
As the levees breached, causing massive flooding to 80% of Orleans Parish, EMS professionals found themselves facing many challenges in what quickly became unimaginable conditions. Usual operations of providing medical care and hospital transports were impossible to accomplish due to the massive flooding on nearly every road in the city. While waiting for the waters to recede, medics continually tried to salvage critical equipment, conduct water rescue of stranded survivors, and serve as a ground guides in make-shift landing zones for helicopters to land safely for evacuee transport.
Use of the New Orleans Superdome ramps were instrumental in providing access to dry land for establishing a base camp to gather crews, equipment and vehicles from the rising floodwaters. Once established, crews were preparing patients for evacuation from the Superdome to the Louis Armstrong Airport using the helipad, Cedric Palmisano, deputy chief of special operations and logistics, recalled. An estimated 20,000 citizens were in need of evacuation.
Major disasters are known to have a catastrophic impact on the local medical infrastructure when the need for resources is limited and there is a sudden influx in injury or illness in a short period of time to the population.
A-MED Ambulance Service Director, Marco Macera, remembered the struggles in providing medical aid to neighborhoods located on the west bank of the Mississippi River in the New Orleans metropolitan area during Katrina response. He advised, “there is no such thing as over-planning for an event like Hurricane Katrina. That said, an organization must have in place underlying concepts and practices that are flexible enough to allow for reaction adjustments to any and all unknown variables as they arise (and they will).”
Several adjustments were needed to ensure emergency responders were able to continue to help survivors evacuate to higher ground while assessing the sick and injured. Challenges in survivability, safety, operations and extrication arose as crews continued their mission to evacuate an estimated 25,000 evacuees from the New Orleans Ernest N. Morial Convention Center.
“Have a plan, a back-up plan and contingencies for your back-up plans,” Nick Culotta, former paramedic for the New Orleans Health Department advised. “Always expect the unexpected. Pay attention to your surroundings: what’s going on ahead of you; what’s going on behind you.”
2. Be prepared for primary and back-up communications failures
What is your primary and secondary communication plans during a catastrophic disaster? Is a third back-up plan necessary? How does your organization communicate with neighboring agencies on a local or state level?
The loss of communication capabilities in New Orleans was a major obstacle for emergency responders following the levee breeches during Hurricane Katrina. Survivors were not able to call 911 for help due to the damaged cellular towers and downed phone lines. Emergency responders were not able to communicate with dispatch or reach survivors in need of help. “We lost communications and were on our own, so we did the best we could with what we had,” Palmisano said.
One of the most important resources discovered during Katrina response was the need for central communications capability. Recognizing this need, the Governor’s Office of Homeland Security & Emergency Preparedness funded the Louisiana Wireless Information Network (LWIN) to allow emergency responders and public health officials from various jurisdictions throughout the state a capability to share information using a P25 compliant 800mHz portable radio system with programmed interoperability frequencies at no cost to emergency responders.
3. Be prepared for emotional support needs
What support system does your organization have in place before, during, and after a catastrophic disaster to help your workforce cope? How will your organization implement new or changed policies/programs to receive consistent support with mental health challenges? How will you help them adjust to the new normal following an incident?
In 2018, the Substance Abuse and Mental Health Services Administration published a research bulletin focused on substance abuse and mental health challenges for first responders during normal operations and major disaster incidents, and identified the core of risk factors for EMS professionals in these conditions was the pace of their work [11]. Bentley et al. found that 69% of EMS professionals have never had enough time to recover between traumatic events [2]. High level stress and increased ops tempo can exacerbate mental health challenges.
Culotta recalled that it “tested every cell in my body.” He offered some advice to other first responders who may find themselves in the same austere conditions.
- “You have to first understand yourself. Know your strengths and weaknesses.”
- “Don’t discredit the stress and the strain of the situation. It is too much to bear by yourself. Talk about it! It is important, not only to you but to your family as well.”
- “Understand who you are as a person and as an EMS professional. What can you bring to the team that is useful?”
- “You’re going to learn a lot about the people you work with. You’re going to learn a lot about yourself. Those lessons should humble you (and they did).”
Culotta has since added to his paramedic skills to pursue a career as a critical care flight nurse for a local team in New Orleans. Although 18 years have passed, his memory of the events following August 29, 2005, will forever remain with him and his family.
Katrina 4: Oakwood Center, a major mall on the west bank of the Mississippi River in the New Orleans Metropolitan Area, was set on fire by looters. Local paramedics, Ryan Brown (left), current Gretna Police Department EMS commander; Steve Brown (center), former West Jefferson Medical Center EMS director; and Joseph Cancienne (right), current West Jefferson Medical Center EMS director, assisted in providing medical aid on scene to firefighters during Hurricane Katrina response.
Photo/Joseph Cancienne
In an Environmental Public Health workshop held a few years after the levee breaches, Dr. Lynn Goldman, pediatrician, epidemiologist and former assistant administrator for the Environmental Protection Agency’s Office of Prevention, Pesticides and Toxic Substances, expressed her gratitude to all first responders who served during Katrina rescue efforts by stating [3]:
“This was one of the first disasters in the United States in which medical assistance beyond the local medical community was required. Given the unprecedented nature of this natural calamity, the first responders deserve a lot of praise for their efforts. This is not likely to be the last major disaster, and therefore public health officials and first responders need to be able to learn from it in order to prepare for potential future events. At the same time, they need to move forward to address the needs and concerns of the people who have been impacted by this disaster.”
It is normal to think in terms of what life was like before and after a large-scale disaster such as Hurricane Katrina. The resiliency of moving forward while learning from the past provides a unique opportunity to shape new norms and influence change to improve future response.
Read next: Training day: Disaster response, transporting patients from the scene
References
- A-MED Ambulance Service. https://www.amednola.com/
- Bentley, M. A., Crawford, J. M., Wilkins, J. R., Fernandez, A. R., & Studnek, J. R. (2013). An assessment of depression, anxiety, and stress among nationally certified EMS professionals. Prehospital Emergency Care, 17(3), 330–338. https://doi.org/10.3109/10903127.2012.761307
- Goldman, L. Environmental Public Health Impacts of Disasters: Hurricane Katrina: Workshop Summary (2007). The National Academies of Sciences Engineering Medicine. https://www.nap.edu/read/11840/chapter/3
- Louisiana Department of Health https://ldh.la.gov/index.cfm/subhome/17
- Louisiana Wireless Information Network (LWIN)
- http://gohsep.la.gov/ABOUT/UNIFIED-COMMAND-GROUP/Interoperability-Subcommittee/LWIN
- New Orleans Emergency Medical Services. https://www.nola.gov/ems/
- Post-Katrina Emergency Management Reform Act (PKEMRA) of 2006
- https://www.gpo.gov/fdsys/pkg/PLAW-109publ295/pdf/PLAW-109publ295.pdf
- Oberman, J. (2005) Behind Katrina’s Eye with New Orleans EMS. Iss. 11 Vol.30 Retrieved from https://www.jems.com/2005/11/01/behind-katrina-s-eye-with-new-orleans-ems/
- Substance Abuse and Mental Health Services Administration. First Responders: Behavioral Health Concerns, Emergency ... (2018). www.samhsa.gov
- The Data Center https://www.datacenterresearch.org/data-resources/katrina/facts-for-impact/
- U.S. Department of Homeland Security. Louisiana Superdome Sheltering and Repair Audit Report Number DD-09-06. DHS OIG. Retrieved from www.oig.dhs.gov
This article, originally written in September 2020, has been updated.
