Physicians' e-mails document post-Katrina horrors

Providing care in hurricane-battered areas was compounded by shortfalls in the National Disaster Medical System.

American College of Emergency Physicians post-Katrina field reports

E-mail messages from emergency physicians working in the Gulf Coast region in the wake of Hurricane Katrina describe scenes of Dickensian horror at makeshift hospitals so bad, in the words of Dr. Hemant Vankawala, they are “almost impossible to comprehend.”

Shortfalls in the Homeland Security Department’s National Disaster Medical System (NDMS) compounded the difficulties in providing care in hurricane-battered areas, emergency physicians said.

Vankawala worked on a 30-person medical team that evacuated 15,000 patients from the Louis Armstrong New Orleans International Airport in a single day last week. He said medical care was minimal and rudimentary.

A physician in Denton, Texas, Vankawala was deployed to New Orleans with a Federal Emergency Management Agency Disaster Medical Assistance Team. “All we could do was provide the barest amount of comfort care,” he wrote in an e-mail message. “We watched many, many people die. We practiced medical triage at its most basic, black-tagging the sickest people and culling them from the masses so that they could die in a separate area.”

In an e-mail message the American College of Emergency Physicians provided to the media, he added, “I cannot even begin to describe to transformation in my own sensibilities from my normal practice of medicine to the reality of the operation here. We were so short on wheelchairs and litters we had to stack patients in airport chairs and lay them on the floor. They remained there for hours too tired to be frightened, too weak to care about their urine- and stool-soaked clothing, too desperate to even ask what was going to happen next.”

When it came time to evacuate these patients, Vankawala said, they “were loaded onto baggage carts and trucked to the baggage area like, well, baggage. And there was no time to talk, no time to cry, no time to think, because they kept on coming.”

The situation he and his colleagues encountered in New Orleans outdistanced any disaster in recent memory, Vankawala wrote. “I have met so many people while down here, people who were at Ground Zero [of the Sept. 11, 2001, terrorist attacks], people who have done tsunami relief, tours in Iraq, and every one of them has said this is the worst thing they have ever seen.”

Dr. Greg Gray, senior medical director for a FEMA team from Oklahoma, began his work in New Orleans at the Superdome and then moved to a temporary medical facility set up at a nursing school in Thibodaux, La. He wrote in an e-mail message that NDMS has to re-evaluate the kinds of medications medical teams have because “we have gone from acute care to refugee care.”

NDMS manages and coordinates the federal government’s medical response to major emergencies and disasters, including sending medical teams, supplies, medicines and equipment and moving patients to hospitals outside the disaster area.

Dr. Marc Rosenthal, a member of a Michigan-based team deployed to Garden Park Hospital in Gulfport, Miss., wrote, “This deployment has definitely stretched the NDMS system as well as the teams. Many facets will need to be reviewed following this deployment, especially the medication cache."

Rosenthal said his team was seeing a lot of dehydration, puncture wounds, cellulitis and abscesses. One concern is methicillin-resistant Staphylococcus aureus, a type of bacteria that is resistant to certain antibiotics.

"We also are seeing a significant amount of vomiting and diarrhea with no [intravenous] antiemetics provided by NDMS, and so far they have not fulfilled our requests for it. Therefore, we have to be innovative and also ask the hospital for these medications," he wrote. "It should be the other way around.”

Dr. Ray Swienton, a professor at the University of Texas Southwestern Medical Center at Dallas working at the Louisiana state operations center, summed up the health care situation in the Gulf Coast region just days after the hurricane hit: "This situation is worse than most of my Third-World experiences.”

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