The following is a letter from a physician at Charity Hospital in New Orleans, LA. I received this via email today from a friend who works at a trauma hospital in Memphis, TN. It's a little long but I thought it well worth passing on.
Chris
Subject: From Ben deBoisblanc
Thanks to all to have offered help in the aftermath of Hurricane Katrina. The physical destruction you see on television does not begin to tell the story of the emotional desolation felt by the tens of thousands of poor who have lost everything. Please continue to help in any way that you feel you can.
Thanks to all, Ben.
P.S. below is a brief accounting of our ICU operations in the wake of Katrina.
Prior to landfall it was obvious that Katrina had all the characteristics of the hurricane experts for decades had predicted would be the worst natural disaster in US history...a category 5 storm hitting a city that is largely below sea level and one that is completely surrounded by water. We were able to reduce our ICU patient load in Charity Hospital to about 50. After evacuating our families, our emergency activation team set up to provide medical support for the remaining patients. During the storm windows blew out in the ICU flooding it with about 2 inches of water. The power went out but the emergency generators kicked on and all seemed well. But an hour later for some unknown reason we lost all power and began bagging our patients in total darkness. We were able to restart the backup generators late in the day on Monday which allowed us to start cleaning up the mess in the ICU. Although the city was without power, we were high-fiving each other over a job well done. The day crew went to sleep late Monday but was suddenly awakened at 3AM on Tues to help bag patients when the emergency generators went out again. As dawn began to break we began to understand why, water was pouring into downtown New Orleans from every direction and had flooded the generators that we located on the first floor.
Without power for our life support systems (suction, monitors, vents, dialysis, IV fluid pumps, radiology, laboratory, etc.) we realized that we needed to get our patients out ASAP. Soon after, a sanitation crisis unfolded when we lost water pressure for toilets. We were not only caring for 300 patients in the hospital but we we also providing refuge for over 1000 support staff and their families. Before we lost communication with the outside world FEMA instructed us to prepare for evacuation later on that day (Tues) and much to our surprise the Governor's office was telling news agencies that we had already been evacuated. Needles to say, no outside help came until Friday.
It began to become clear that if we were going to get out, we would have to get ourselves out. Our HAZMAT Team had acquired 4 small diesel generators for field use but did not have diesel fuel on site to power them. Our ICU RT used his "Mississippi Credit Card" (a hammer and a screwdriver) and some oxygen tubing to siphon diesel from on ambulance flooded on the ER ramp. We were able to power up the ICU to run about 6 vents. For the others we used gas driven portable vents or continued to hand bag. The roof of Charity Hospital was the only cool place to get a few hours of restorative sleep each night so we broke away form our 12-on 12-off usual staffing plan to allow each shift to enjoy a few hours with the rats seeking higher ground.
When Tues rolled into Wed without any FEMA presence a morale crisis erupted. Although many staff were incapacitated with fear, grief, and despair, others dug deep and rose to the challenge. We could not communicate with police, National Guard, or FEMA but our ICU residents were able to text message and get live connection on air transmissions to CNN. Shortly thereafter Fancesco Simeone, our Tulane ARDSnet Co-I, got a call from private air ambulance services wanting to send in his own helicopters to start the evacuation. The only problem was that the only commercial heliport in the area was at the Superdome which was in the midst of a security crisis.
Joe Lasky, the Chief of Tulane Pulm/CCN paddled a canoe from Charity to find a National Guard 5 ton truck with a driver that was not in communication with his command. This actually worked to our advantage since he could not be accused of disobeying an order by helping us. Wed night we put the first 4 of our patients in the back of the truck and drove then across the street to Tulane Hospital's parking garage. One was 23 y.o. kid with Goodpastures and acute renal failure who had not been dialyzed in 4 days failure and who being bagged with 100% O2 and 12 cm PEEP valve. We had to emergently insert a chest tube in the back of the National Guard truck when he desaturated in the middle of riding through the flood waters. We then used a "borrowed" pick truck to ferry the patients to the roof top where we set up a mini ICU for the next 2 days. After removing light poles, helicopters were able to begin landing but the sun set before we could get any ICU patients to the roof, leaving us with 4 patients and no exit strategy. The commercial guys were able to communicate with military helicopters and by 11PM Wednesday the clap-clap thunder of a Black Hawk was heard overhead. The Black Hawks were configured only as troop carriers which meant that we would have to provide patient support for all of the sorties. The first ride for me was surreal...moonless night, unlit buildings & towers, pilots with night vision goggles. A triage landing site had been established on the edge of town on the interstate. Amazingly there were thousands of people waiting, ready to help but no one had known of our plight. We dumped our patients with brief medical records taped to their forearms into waiting ambulances for dispersion all over the region. A day later I got a call that the 23 y.o. was alive and doing well.
We continued the air evacuation all day Thursday, Thursday night, and Friday AM. Nurses cat-napped on the concrete roof by putting their heads on the legs of colleagues who bagged and comforted those waiting for the next helicopter. Not knowing the structural integrity of the roof top, the Black Hawk pilots stayed powered up while we loaded our patients, docs, & O2 cylinders. After 48 hours of screaming commands over the deafening sound of the Black Hawks our entire ICU staff was both deaf & mute. By Friday afternoon we had completed our mission and walked the three blocks back to Charity in chest deep sewage just in time to discover that FEMA had arrived to begin evacuating our hospital.
I cried when I left Charity, perhaps for the last time ever. Some were tears of triumph, some were tears of profound sadness. Triumph for the miracle of human resolve that allowed a group of civilian doctors, nurses, and respiratory therapists to accomplish what the Federal government could not. We got all of our patients out alive except two. One we expected to die. The other was an incubated elderly lady with COPD whose husband we had had to leave behind at Charity. I remember how he sat day and night fanning his wife in the sweltering heat of the ICU...fanning even as he seemed to slip into sleep. She died in the arms of her resident physician who could do no more on the roof top than comfort her with the touch of a hand. I never saw her husband again as he was evacuated before I got back to the hospital...I don't even know if he knows that she had died. Even if he does know, I somehow feel that he remains profoundly grateful. The sadness is felt because valuable time was lost both due to the anemic early response and because valuable resources were misused. I personally witnessed dozens and dozens of helicopters, many military, land and fly away with able bodied citizens while patients died on the roof top. And sadly, many of those able-bodied citizens were physicians.
It was an experience that I will never forget. I left with one memento, a set of keys of a John Doe with an unknown medical condition that we loaded into a helicopter to be carried to an unknown place with an uncertain future. If you received a John Doe looking for his keys, let me know, I'd love to one day be able return them. Ben
Chris
Subject: From Ben deBoisblanc
Thanks to all to have offered help in the aftermath of Hurricane Katrina. The physical destruction you see on television does not begin to tell the story of the emotional desolation felt by the tens of thousands of poor who have lost everything. Please continue to help in any way that you feel you can.
Thanks to all, Ben.
P.S. below is a brief accounting of our ICU operations in the wake of Katrina.
Prior to landfall it was obvious that Katrina had all the characteristics of the hurricane experts for decades had predicted would be the worst natural disaster in US history...a category 5 storm hitting a city that is largely below sea level and one that is completely surrounded by water. We were able to reduce our ICU patient load in Charity Hospital to about 50. After evacuating our families, our emergency activation team set up to provide medical support for the remaining patients. During the storm windows blew out in the ICU flooding it with about 2 inches of water. The power went out but the emergency generators kicked on and all seemed well. But an hour later for some unknown reason we lost all power and began bagging our patients in total darkness. We were able to restart the backup generators late in the day on Monday which allowed us to start cleaning up the mess in the ICU. Although the city was without power, we were high-fiving each other over a job well done. The day crew went to sleep late Monday but was suddenly awakened at 3AM on Tues to help bag patients when the emergency generators went out again. As dawn began to break we began to understand why, water was pouring into downtown New Orleans from every direction and had flooded the generators that we located on the first floor.
Without power for our life support systems (suction, monitors, vents, dialysis, IV fluid pumps, radiology, laboratory, etc.) we realized that we needed to get our patients out ASAP. Soon after, a sanitation crisis unfolded when we lost water pressure for toilets. We were not only caring for 300 patients in the hospital but we we also providing refuge for over 1000 support staff and their families. Before we lost communication with the outside world FEMA instructed us to prepare for evacuation later on that day (Tues) and much to our surprise the Governor's office was telling news agencies that we had already been evacuated. Needles to say, no outside help came until Friday.
It began to become clear that if we were going to get out, we would have to get ourselves out. Our HAZMAT Team had acquired 4 small diesel generators for field use but did not have diesel fuel on site to power them. Our ICU RT used his "Mississippi Credit Card" (a hammer and a screwdriver) and some oxygen tubing to siphon diesel from on ambulance flooded on the ER ramp. We were able to power up the ICU to run about 6 vents. For the others we used gas driven portable vents or continued to hand bag. The roof of Charity Hospital was the only cool place to get a few hours of restorative sleep each night so we broke away form our 12-on 12-off usual staffing plan to allow each shift to enjoy a few hours with the rats seeking higher ground.
When Tues rolled into Wed without any FEMA presence a morale crisis erupted. Although many staff were incapacitated with fear, grief, and despair, others dug deep and rose to the challenge. We could not communicate with police, National Guard, or FEMA but our ICU residents were able to text message and get live connection on air transmissions to CNN. Shortly thereafter Fancesco Simeone, our Tulane ARDSnet Co-I, got a call from private air ambulance services wanting to send in his own helicopters to start the evacuation. The only problem was that the only commercial heliport in the area was at the Superdome which was in the midst of a security crisis.
Joe Lasky, the Chief of Tulane Pulm/CCN paddled a canoe from Charity to find a National Guard 5 ton truck with a driver that was not in communication with his command. This actually worked to our advantage since he could not be accused of disobeying an order by helping us. Wed night we put the first 4 of our patients in the back of the truck and drove then across the street to Tulane Hospital's parking garage. One was 23 y.o. kid with Goodpastures and acute renal failure who had not been dialyzed in 4 days failure and who being bagged with 100% O2 and 12 cm PEEP valve. We had to emergently insert a chest tube in the back of the National Guard truck when he desaturated in the middle of riding through the flood waters. We then used a "borrowed" pick truck to ferry the patients to the roof top where we set up a mini ICU for the next 2 days. After removing light poles, helicopters were able to begin landing but the sun set before we could get any ICU patients to the roof, leaving us with 4 patients and no exit strategy. The commercial guys were able to communicate with military helicopters and by 11PM Wednesday the clap-clap thunder of a Black Hawk was heard overhead. The Black Hawks were configured only as troop carriers which meant that we would have to provide patient support for all of the sorties. The first ride for me was surreal...moonless night, unlit buildings & towers, pilots with night vision goggles. A triage landing site had been established on the edge of town on the interstate. Amazingly there were thousands of people waiting, ready to help but no one had known of our plight. We dumped our patients with brief medical records taped to their forearms into waiting ambulances for dispersion all over the region. A day later I got a call that the 23 y.o. was alive and doing well.
We continued the air evacuation all day Thursday, Thursday night, and Friday AM. Nurses cat-napped on the concrete roof by putting their heads on the legs of colleagues who bagged and comforted those waiting for the next helicopter. Not knowing the structural integrity of the roof top, the Black Hawk pilots stayed powered up while we loaded our patients, docs, & O2 cylinders. After 48 hours of screaming commands over the deafening sound of the Black Hawks our entire ICU staff was both deaf & mute. By Friday afternoon we had completed our mission and walked the three blocks back to Charity in chest deep sewage just in time to discover that FEMA had arrived to begin evacuating our hospital.
I cried when I left Charity, perhaps for the last time ever. Some were tears of triumph, some were tears of profound sadness. Triumph for the miracle of human resolve that allowed a group of civilian doctors, nurses, and respiratory therapists to accomplish what the Federal government could not. We got all of our patients out alive except two. One we expected to die. The other was an incubated elderly lady with COPD whose husband we had had to leave behind at Charity. I remember how he sat day and night fanning his wife in the sweltering heat of the ICU...fanning even as he seemed to slip into sleep. She died in the arms of her resident physician who could do no more on the roof top than comfort her with the touch of a hand. I never saw her husband again as he was evacuated before I got back to the hospital...I don't even know if he knows that she had died. Even if he does know, I somehow feel that he remains profoundly grateful. The sadness is felt because valuable time was lost both due to the anemic early response and because valuable resources were misused. I personally witnessed dozens and dozens of helicopters, many military, land and fly away with able bodied citizens while patients died on the roof top. And sadly, many of those able-bodied citizens were physicians.
It was an experience that I will never forget. I left with one memento, a set of keys of a John Doe with an unknown medical condition that we loaded into a helicopter to be carried to an unknown place with an uncertain future. If you received a John Doe looking for his keys, let me know, I'd love to one day be able return them. Ben
