WEDNESDAY, Sept. 21, 2005 (HealthDay News) -- Of all the surreal scenes playing out across New Orleans in the aftermath of Hurricane Katrina, this may have been one of the strangest.
As the New Orleans flood waters rose, Dr. Joseph Guarisco, chairman of emergency medicine at the city's Ochsner Clinic Foundation, looked out the center's windows and saw a succession of people perched on boats, rafts and even garbage cans floating by.
Then, finally, a city bus sped through the water. It did not pass the hospital and continue west with the stream but, instead, sped up the ambulance ramp and screeched to a halt. At least there was a dry place to stop: Ochsner is above sea level.
The bus, it turned out, held paraplegics who had been carried down eight flights of stairs at another hospital. The city bus had been commandeered by the paramedics and had been turned away by every shelter and hospital between Ochsner and downtown, a distance of about five miles.
"I'm turning the bus off, parking it and leaving," the paramedic, who was armed, stated.
Guarisco tried to reason with the paramedic: The paraplegics didn't have any acute medical problems, so they really needed to be at a shelter, not a hospital. The hospital needed to be ready for medical emergencies. But the paramedic prepared to leave, so Guarisco summoned Ochsner security (also armed) and, finally, the hospital's CEO.
"The infrastructure of the city was falling apart, police were abandoning their positions, city bus drivers were abandoning running buses. The city's flooding, and here we have paraplegics inside a bus and there's an armed standoff between paramedics and our own security," Guarisco said. "It was right out of a scene about the end of the world."
Ochsner staff finally convinced the paramedic to return the paraplegics to the last shelter they had visited.
The scene was perhaps not too much stranger than other scenes playing out all over New Orleans and, indeed, throughout the Gulf Coast after Katrina unleashed her fury at the end of August.
At the heart of so many of those stories, men and women trained in emergency care used whatever resources were at hand to help others struggling against chaos, confusion and death.
Chapels and operating rooms were turned into makeshift morgues, corpses floated in nursing homes and Federal Emergency Management Agency (FEMA) officials commandeered transportation away from hospitals and nursing homes, according to news reports.
Some patients waited up to 12 hours in stairwells waiting to be airlifted, only to be told it wasn't going to happen that day. There were reports of one hospital evacuating its staff before sick infants. Some 90 patients died in area hospitals, the news reports found.
At the New Orleans International Airport, Concourse D became the initial triage and treatment center for thousand of evacuees from nursing homes, hospitals, private homes, civic centers and the Superdome.
By the time Dr. Russell Bieniek arrived from Erie, Pa., as part of a disaster medical assistance team, the overflow had taken over the rest of that floor and the floor below it.
"It was wall-to-wall people waiting for care and transport," said Bieniek, who is medical director of the emergency department at St. Vincent Health Center in Erie. On the busiest day, about 12,000 people came through.
While many patients simply required wound and other minor care, others were critical.
"Most of the evacuees had not had any medical care in four or five days. This meant no dialysis, blood pressure meds, cardiac meds, seizure meds, insulin," Bieniek. "We had a man having an acute heart attack, several patients seizing, a woman nearing cardiac arrest from high potassium because she missed her dialysis, and many people with sugars out of control from not having any insulin where they were."
For several days, Bieniek slept in the baggage claim area and took showers in a trailer provided by the forestry service and parked between C and D concourses. The number of patients being treated at the airport had dwindled to by the end of the first week of September as patients were moved elsewhere.
In the parking lot of the Houston Astrodome, where thousands huddled in the weeks after the storm, doctors waiting to treat patients arriving by bus saw many of the same issues: chronic diseases gone awry because patients had no access to medication.
Several people were admitted to hospital with diabetic ketoacidosis -- a dangerously high level of ketones, or acids, that build up in the blood and can lead to diabetic coma or death, said Dr. Clinton White, a professor of internal medicine at Baylor College of Medicine and chief of infectious disease at Ben Taub General Hospital, both in Houston.
One person appears to have died of a heart attack because his blood pressure had skyrocketed, said White, who is also a counselor with the American Society of Tropical Medicine & Hygiene.
During that first chaotic weekend in September, medical staff were suddenly faced with an outbreak of diarrhea in the Astrodome. "Hundreds of people were getting sick," White said.
Medical personnel blocked off one area of the arena to isolate people while labs ran tests for free. The culprit turned out to be norovirus, the same germ responsible for many illnesses aboard cruise ships.
The problem was that people in the Astrodome and adjacent Astro Arena were using alcohol disinfectant, which doesn't work well for this particular organism. White had more sinks put in so people could wash with soap and water.
Dr. Hilarie Cranmer was driving to Boston's Logan Airport, preparing to fly to France to speak about her experiences tending victims of the Asian tsunami, when her cell phone rang.
It was the Harvard Humanitarian Institute asking her to fly to Louisiana to help the Red Cross coordinate disaster efforts. She turned the car around and repacked for Baton Rouge.
The devastation, especially in Mississippi, looked a lot like that from the tsunami, Cranmer recalled. And, again, thousands upon thousands of people were displaced. Cranmer was charged with helping to coordinate with the various shelters, making sure they had what they needed.
This proved more difficult than anticipated.
"One of the hardest things was to actually find out where the shelters were because the communications were down," Cranmer said. "We knew there were shelters out there, but we couldn't know what they needed because we couldn't get through." Eventually, they did, and made sure that basic public health standards were being met, things like separating trash from food and cleaning up overflowing toilets.
The Ochsner emergency room saw just a handful of patients during the storm. Once the water started rising, however, they saw people stranded, starved, dehydrated and/or elderly wandering out of the city. "A lot of people were without basic resources of food, water and medication," Guarisco said. "There was a tremendous amount of despair and helplessness. It was truly as if someone had dropped a bomb in the middle of the city."
That stream of desperate individuals included even fellow rescue workers injured in accidents.
Still, as yet another storm -- Hurricane Rita -- loomed Tuesday, Guarisco said Ochsner's emergency department has gotten "back to regular business," ready to face what comes.
At least for now.
More information
For more stories from emergency medical personnel doing rescue work after Katrina, visit the American College of Emergency Physicians.
