—Ben DeBoisblanc, MD
“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. Subsequently, a sanitation crisis unfolded when we lost water pressure for toilets. We were not only caring for 300 patients in the hospital but we were also providing refuge for more than 1,000 support staff and their families. Before we lost communication with the outside world on Tuesday FEMA instructed us to prepare for evacuation later that day. Much to our surprise the governor’s office was telling news agencies that we had already been evacuated. Needless to say, no outside help came until Friday, despite FEMA’s instructions.
“It soon became clear that if we were going to get out, we would have to get ourselves out. Our hazmat team had acquired four small diesel generators for field use, but did not have diesel fuel on site to power them. Our ICU respiratory therapist used his ‘Mississippi credit card’ (a hammer and a screwdriver) and some oxygen tubing to siphon diesel from on ambulance flooded on the ED ramp. We were able to power up the ICU to run about six 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 from our 12-on, 12-off usual staffing plan to allow each shift to enjoy a few hours with the rats seeking higher ground.
“By Wednesday we were still without any FEMA presence, and a morale crisis erupted among the employees. 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 on-air transmissions to CNN.
“On Wednesday, Francesco Simeone, a colleague from Tulane got a call from private air ambulance services wanting to send in their 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 pulmonary services, paddled a canoe from Charity and found a National Guard five-ton truck with a driver that was not in communication with his command. This actually worked to our advantage because he could not be accused of disobeying an order by helping us.
“Wednesday night we put the first four of our patients in the back of the truck and drove them across the street to Tulane Hospital’s parking garage. One patient was 23-year-old kid with Goodpasture’s and acute renal failure who had not been dialyzed in four days and who being bagged with 100% O2 and a 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 floodwaters.
“We then used a ‘borrowed’ pick-up truck to ferry the patients to the rooftop of a parking lot adjacent to Charity Hospital, where we set up a mini-ICU for the next two 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 four patients and no exit strategy for getting them out of New Orleans. The commercial ambulance personnel were able to communicate with military helicopters and by 11 p.m. 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.