AcknowledgementsMany people contributed generously to the creation of this book, and I am grateful to them all. Thanks to those who helped edit the text and suggested ways to im-prove it. Terry Daniel played an important role in the first draft. Thanks also to her assistants, Chrystal Wadsworth and Annette Brown.

Thanks to the stranded medics that helped in the Superdome: Stephanie Korzyk (New York), Mark Gerano (Ohio), Vickie Kock (Ohio), Sean Schuman (South Da-kota), Duane Quakendosh (South Dakota), Phillip C. Yellow Hawk (South Dakota), Deanna Lassegard (South Dakota), Rob Menacher (South Dakota), and Will How-land (Louisiana National Guard).

Thanks to stranded physician, Dr. Tran Vo from New York, for helping our medics in the Superdome.

Thanks so much to my family who have been a continuous source of support throughout my life, and especially during the trying times of Hurricanes Katrina and Rita. Special thanks to my three brothers - Ronnie, Roch, and Remi - who jumped on a helicopter at a moments notice...to help me at the Superdome. Seeing them arrive at the helipad confirmed what I already knew - I have a great family.

Thanks also to Robin Roughton Judice, my wife, who not only supported this writ-ing project, edited the book, but also kept me emotionally grounded during the af-termath of these storms.

Thanks to my dad, Ronald Judice, Sr., for proofreading and editing the book, and for teaching me to be courageous.

Thanks to the men and women of Acadian Ambulance Service who inspire me every day with their compassion and professionalism. For reaching into the misery of Hurricane Katrina and pulling so many people out of despair, I dedicate this book to them, and to all the first responders and EMS personnel that pulled together to help.

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ContentsIntroduction 4

Prologue: The Lay of the Land 8

By Air, Land, & Sea 16

Life and Death on the Interstate: The I-10 and Causeway Cloverleaf 25

The Children 32

The Elders 39

Rescuers in the Storm 45

Sick, Disabled 59

The Animals 64

Superdome 67

Crime 80

St. Bernard 87

Organizing Chaos 90

Difficult Communications 103

Reflections 107

Epilogue 113

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IntroductionThere have been dozens of books written about Katrina, the Category 5 hurricane that leveled long stretches of the Gulf Coast from Florida to Texas and decimated the city of New Orleans in August 2005. The story has been told countless times by survivors, politicians and journalists who were there on the front lines, witnessing the devastation as it happened. Their stories express the unimaginable horror of see-ing the bodies of dead men, women, children and animals floating in the putrid floodwaters. They tell of personal loss, grief and devastation. They shine a harsh light on poverty and politics. It has been five years since Katrina, and most of us have heard it all.

But this story is different.

We are the paramedics, EMTs, doctors, nurses, administrators, support staff and volunteers who were on the scene before, during and after Katrina. We were pre-sent from the pre-storm evacuations, during the storm, and throughout the surreal and unexpectedly tragic aftermath. The accounts you will read in these pages are told first-hand by healers...the people who treated the wounds of the traumatized and injured, held the sick and dying in their arms, and did their best to create a ha-ven of safety in the midst of terror and chaos.

Katrina gave us an extraordinary new!perspective on the work we do.!We are ac-customed to school bus accidents, murders, heart attacks, suicide attempts and human suffering of all kinds. We are used to pulling mangled bodies out of multi-vehicle car crashes, but we!never imagined that Katrina would require us leave our ambulances and offices and face the unknown to care for a sea of suffering New Orleanians. We also could not anticipate that some of the people we were trying to help would end up shooting at us, or that we would run short of supplies, medicine and equipment.

In the Emergency Medical Services (EMS) business, Katrina is what we call a “mass casualty incident." But we -- along with most everyone else in the southern states -- never expected it to elevate to such a desperately critical level. Medics compared it to being in a combat zone, and many of the military medics who worked alongside us said that they'd never seen anything like it.

From 1998 to September 2010, I served as the medical director of Acadian Ambu-lance Service, Inc. (“Acadian”).1 Acadian is based in Lafayette, LA 135 miles west

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1 At all times pertinent to this narrative, the author served as medical director of Acadian and continued as such until September 2010 - hence the use of the terms “we”, “us”, and “our” when speaking of Acadian and its staff.

of New Orleans. Most of us rode out the hurricane in our own homes. After the storm passed, we walked outside to find blue skies and gentle winds blowing, just like any other summer day in Louisiana, and it seemed that the area had emerged relatively unscathed. But that was before we knew that the levees had broken and the low-lying areas of New Orleans were beginning to flood. There was no electric-ity or phone service, so news of the flooding didn't reach us until the next morning.

As I packed to accompany our paramedics into New Orleans to begin our medical relief operations, I threw my video camera into my duffle bag with the intention of videotaping some of the work we’d be doing. I didn’t realize at the time that I would be way too busy to carry a camera around. In fact I didn’t even open the bag until three or four days later. I was disappointed that I had not been able to docu-ment something that most people never see… the medics’ point of view.

Then I got an even better idea. I sent one of my employees in Lafayette to purchase ten digital voice recorders from a local electronics store. I handed one of these re-corders to each of my key staff members with these simple instructions: record your experiences and impressions. They in turn passed the recorders on to others so that the first hand accounts would be captured.

The stories in this book are transcriptions of those recordings. I recognized that this was a disaster like no other, and I wanted to make sure the world knew how it looked through the eyes of the emergency medical personnel on the scene. Some of the people you'll meet in these pages have worked in EMS for decades. Some lost their homes, their possessions, and their pets in the storm. Most worked 20 or 30 hours non-stop in the Superdome, on the freeway underpass that became a makeshift triage2 center, in helicopters, in ambulances, in boats and in our offices, doing whatever needed to be done to meet the needs of an entire city of refugees. The intent of the book is to document both the deep compassion and the frustration of Acadian's responders. The stories told by these medics and staff will shock you and touch your heart with their expressions of brotherly love, human kindness and human vulnerability. Although I am extremely proud of my Acadian colleagues, there were countless others who helped with equal dedication. Some of those in-clude the Coast Guard, the National Guard, FEMA, hospitals, EMS, medical profes-sionals, civilian helicopter companies, churches, civic organizations, local busi-nesses and local fire & police departments. Then there were the friends, neighbors and average folks who helped by cooking meals for our medics, bringing us clean clothes, offering their boats, tools and manpower and assisting us in a hundred dif-ferent ways.

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2 Triage is the assignment of degrees of urgency to wounds or illnesses to decide the order of treatment of a large number of patients or casualties. Medics are trained to triage patients in disaster situations.

The stories being published herein have not been confirmed or endorsed by Aca-dian as to their accuracy or content. Acadian takes great pride in the work and dedication of its employees, not only in times of disaster but every day that they commit themselves to a mission of service. In looking back on the days and weeks and months following Hurricanes Katrina and Rita, there was an overwhelming de-gree of humanity, persistence, skill, integrity and endurance that was displayed in the field and at home. The faces of those whose lives were touched and who touched every member of the Acadian family in the wake of those storms will never be forgotten.

We walked with angels during that time. We were reminded that material things can be washed away, but that the human spirit is eternal. Ross Judice, MD

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Prologue: The Lay of the LandAs you read, you will see numerous references to locations such as the Superdome, the Arena, the I-10/Causeway cloverleaf, St. Bernard Parish, Lafayette and other sites that figure prominently into the story. You will also read medical terminology that you may not understand as you read the first-hand accounts from medics. This prologue will provide a valuable key to understanding the sequence of events and some of these references. A day-by-day timeline is set forth at the end of this Pro-logue.

Acadian Ambulance has had the first aid station and standby contract with the New Orleans Superdome since 2004. During football games, rock concerts and other events at “the Dome,” a core group of our medics is based in a small first aid area on the middle level of the Superdome, while others are scattered around the sta-dium. When it became clear that a monster hurricane was due to hit New Orleans on Monday morning, the city ordered a mandatory evacuation and set up the Su-perdome as a “refuge of last resort” for people who needed a safe place to take shelter from the storm.

As the contracted medics for the Dome, we manned our usual post on Sunday, and because the high winds could potentially blow out the glass doors at all the Dome’s entrances, we parked an ambulance in front of each door to serve as a wind barrier. Then we watched the Dome slowly fill with people, mostly the poor, elderly and indigent who didn’t have cars to take them out of town or money to stay in a hotel on higher ground.

Besides the medics stationed at the Superdome, other members of our staff were busy evacuating patients from hospitals and nursing homes and taking them to other hospitals in safer areas. The evacuation effort went smoothly given the mas-sive scope of the effort. By Sunday night we’d moved most of the patients and re-turned to our homes to hunker down with our own families until the storm passed.

Coincidentally, the annual EMS Expo and conference was being held in New Or-leans that weekend. This is North America’s largest gathering of emergency medical personnel, and there were perhaps 2000 paramedics, nurses, doctors and other emergency medical practitioners in town. Acadian had quite a large presence there; many of our staff members were in attendance. We were also exhibitors at the expo and provided speakers at the conference.

Throughout the conference everybody watched the news and kept abreast of the storm’s movements. By Saturday night the winds had changed and Katrina was heading directly toward New Orleans. When the mandatory evacuation was an-

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nounced, some conference attendees managed to get early flights out. Many others found themselves stranded at either the hotel or the airport once all the flights had been cancelled. Car rentals were the next option, but the roads were jammed with evacuees and it took five hours to travel a distance that normally took one hour. As a result, hundreds of EMS people were left in New Orleans, and many of them pitched in to help. Several came to the Dome with us.

As an interesting aside, my wife and I had just sold our vacation condo in the French Quarter. We’d spent most of that week packing up our belongings to take back to our home in Lafayette, where Acadian is headquartered. I recruited some of our guys who were in town for the conference to help us move. We had everything loaded up and were able to get out of town just minutes before the evacuation or-der came in and the traffic started to back up.

The storm hit on Monday morning as expected. Back in Lafayette it wasn’t too bad, and after the storm had passed, things appeared to be calm and under control. But by mid-morning in New Orleans the lower 9th Ward levee breach poured 6-8 feet of water in that neighborhood. By mid-afternoon, the 17th Street Canal breach flooded 20% of the city. Severely damaged communication systems limited infor-mation to the outside world. It wasn't until late Monday night and during the early hours of Tuesday morning that our dispatch center began getting scattered reports about the extent of the flooding and devastation. Now, 80% of the city was flooded. We immediately jumped into high gear.

The first order of business for Acadian was to begin mobilizing flight medics to fly our helicopters to New Orleans to assess the situation at the hospitals. We also needed to relieve the staff that had been at the Dome’s first aid station since Sun-day. I assembled a group and we traveled by helicopter from Lafayette to New Or-leans. We could not believe what we saw on the ground as we flew over...the city was an enormous lake. Nobody expected the levees to break (except the engineers and experts who’d predicted it years earlier, but that’s another story). Because there was no power, communications were crippled, so nobody knew what the condi-tions were from one location to another. The landlines were all down. Few cell phones worked because the towers that hadn’t blown down were operating on generators. Those generators eventually flooded too. Luckily we had satellite phones and were able to acquire some radios and other communications equip-ment over the next several days.

After we arrived at the Superdome, the population of refugees starting growing. Thousands of people were arriving, wading through chest-high water to get to the only shelter they could find. Our little first aid station provided the only medical care available to the public at that point, and we quickly realized that this would not be enough. The Dome is an enormous place, but thankfully, we had two or

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three “Gators,” which are like golf carts that function as mini-ambulances. We drove them around the Dome picking up the sick and injured and taking them back to our first aid station.

We were inundated with requests for help inside and around the Dome. Sometimes we left the first aid station by foot or in the Gator to assess and triage people: in the football stands, hallways, on the field, outside, or wherever we were needed. Mothers arrived with their babies, sons with their mothers, wives with their hus-bands - most with worsening chronic medical conditions like diabetes and heart disease, and others with mild traumatic injuries from the rough conditions wading through the flood waters. The demand for medical care soon outweighed our abil-ity to supply it. Conditions in the Dome were rapidly deteriorating.

We didn’t yet know that one of FEMA’s Disaster Medical Assistance Teams (DMAT) had arrived and set up a treatment station at the New Orleans Arena. The Arena is a smaller building next to the Superdome where the NBA’s New Orleans Hornets play (see the site map at the back of this book). The two arenas are connected by a raised walkway. News of the flooding and the increasing number of refugees was spreading, and rescue teams were beginning to arrive from all over the country.

We sort of stumbled upon the DMAT people. When we realized they were there we collaborated to create a system for transporting serious patients to their station, which was better equipped to deal with critical medical issues. Soon the DMAT area filled up with patients, and there was no place to keep them and no way to evacuate them. There were not yet helicopters and only limited military assistance.

I called our dispatch on the satellite phone and asked them to send our six helicop-ters to the Dome so we could move patients to hospitals, but all our helicopters were busy in other parts of the city. A few minutes later I got a call back saying that some medically-equipped helicopters owned by Petroleum Helicopters Incorpo-rated (PHI), which primarily serves offshore oil rigs, had arrived at the Dome to help out. Because communications were so bad and the Superdome was so big, nobody knew that these PHI helicopters had landed, and their nurses and medics didn’t know where to find us. I made my way over to the Superdome helipad and there they were, waiting for instructions.

Finally I had an idea where everybody was: our first aid station was inside the Dome, the DMAT area was in the Arena, and the PHI helicopters were at the heli-pad. It was time to start connecting the dots. We had some portable radios...the guys on the Gators had one and the first aid station had one, so I positioned one of my staff at the DMAT area with a radio, and positioned myself at the helipad to be-gin directing traffic.

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The Gators buzzed around the Dome picking up people and bringing them to our first aid station. The critical patients were transported along the elevated walkway to the DMAT area. After they were treated at DMAT, they’d be put back into the Gators and driven over to the helipad. From there they were flown to a makeshift hospital at Louisiana State University’s basketball arena (the Pete Maravich arena nicknamed the “P-Mac”) in Baton Rouge.

This system worked, but only for a short while. The flight from the Superdome to the P-Mac was a 90-minute round trip flight, but we soon ran short of helicopters because the number of patients was increasing by the minute. We couldn’t be without our helicopters for that long. Earlier in the day, Acadian leaders dispatched 30 extra ambulances to a staging area that we’d set up at the Interstate 10 overpass at Causeway Boulevard in Metairie. It was only a six-minute helicopter flight from the Dome to I-10/Causeway and outside the floodwaters with a direct drive to Ba-ton Rouge. The overpass was in a “cloverleaf” configuration, and it turned out that each of the cloverleaves could serve as a helipad. It was a brilliant solution. The helicopters could take people from the Superdome to this new site and be back in six minutes to pick up another load.

When we set up on the I-10, thousands of people started showing up. Word was out that we were there, and people started coming from everywhere, wading through the water in search of dry ground, medical care, food, water, shelter...any relief they could find. Rescue helicopters began dropping people off there. Soon the I-10 cloverleaf was a mess.

Back at the Dome, military trucks started arriving with intensive care unit “vent” pa-tients who’d been evacuated from hospitals. These are patients who cannot breathe on their own and rely on electrically powered ventilators to move air in and out of their lungs. Without a ventilator, they die immediately. When someone like this is rescued, they have to be “bagged,” which means that a manual breathing apparatus is used. It looks something like a bellows with a tube that blows air into the pa-tient’s lungs. The bellows, or bag, has to be squeezed by hand to keep the air flow-ing. These ventilator-dependent patients became a priority over the Superdome pa-tients, and put in the front of the line for helicopter evacuation.

We later heard many stories about hospital staff members who took turns for hours on end bagging ventilator patients after the electricity went out. Many hospital em-ployees chose to stay at their hospitals rather than go home to ride out the storm, because a hospital is a usually safe place to be in an emergency. Some of these employees even brought their families, so there were plenty of helping hands when it became necessary to bag patients. Even the teen children of the staff members were enlisted to help with this task of “bagging” the patients. Because many of

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these patients were terminally ill, some people disagreed with the decision to bag them, believing it would be more effective to use the manpower elsewhere.

At the Dome there had been reports of rapes and murders, and we’d heard that snipers were shooting at anybody in uniform. A “fog of war” set in as the National Guard MP's warned us that the generators would soon flood and the lights would go out, and the criminal element would take advantage of the dark to attack us and steal our medical supplies. The MP's advised us to remove our command vests, hide our stethoscopes and try to blend into the population so we wouldn’t be tar-geted.

We formulated an escape plan in case of rioting which instilled an “enemy out there” mindset that stirred my staff into a panic. There were tens of thousands of people in the Dome, many of them were sick and dying. There was no electricity, no plumbing, limited water and food. People were urinating and defecating wher-ever they could. Between the smell of human waste, sweat and death, and increas-ing fear, it was unbearable to be inside. By Wednesday there were military and Coast Guard helicopters, plus our fleet, the civilian helicopters and Hueys, and Blackhawks as far as the eye could see. Ambu-lances came from different companies around the county. All we did, day and night, was move patients out of New Orleans as fast we could. FEMA established a field hospital at the New Orleans airport, and by Thursday we were able to fly peo-ple directly to the airport, where they would be sent to various hospitals around the region.

We moved our first aid station outside with an MP escort. The DMAT people were still in the Arena, which was more secure, but there were now thousands of sick and injured patients needing help, and they were getting sicker all the time. People fled their homes without bringing their prescribed medications, and if they did bring their medications, the pills got soaked as the people walked through the wa-ter. There were un-medicated psychiatric patients, dialysis patients, diabetics, eld-erly people having strokes and heart attacks, sick children, women giving birth and people dying from dehydration. It was a nightmare. By Thursday, with rumors of crime escalating, we decided to vacate the premises and move our entire operation to the field hospital on the I-10 cloverleaf.

There were so many people being transported that we’d long since abandoned the protocol of setting up medical charts and collecting personal information about the patients. We were loading people into helicopters and flying them out so fast there just wasn’t time to keep track of them. Family members didn’t know where their loved ones were being taken, and neither did we. People were transported to hospi-tals and shelters all over the Southeast with without records, but there was nothing

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we could do about it. At this point, nothing mattered more than getting those folks out of the Dome to safety.

Below I’ve included a timeline of events relevant to our story. Naturally, this is not an exhaustive list of what happened, but will provide some “big picture” context to the stories that follow.

Hurricane Katrina Timeline

Friday, Aug. 26, 2005:• Louisiana Governor Kathleen Blanco declares State of Emergency

Saturday, August 27, 2005:• New Orleans Mayor Ray Nagin declares State of Emergency. Orders volun-

tary evacuation where residents in low-lying areas encouraged to evacuate

Sunday, August 28, 2005:• Hurricane Katrina becomes a Category 5 storm with 160 mph winds• Superdome opens as a “shelter of last resort”• Acadian personnel are deployed to the Superdome to help triage special

needs patients and staff the first aid station• Nagin announces that buses will pick people up throughout the city and

take them to the Superdome• Nagin orders mandatory evacuation of the city• Superdome now has 10,000 people inside and 150 National Guardsmen

stationed inside (most are unarmed)• National Weather Service predicts levees may be overtopped

Monday, August 29, 2005:• At 6:10 a.m. Hurricane Katrina becomes a Category 4 storm with 145 mph

winds and makes landfall• Lower 9th Ward levee is breached with reports of 6-8 feet of flooding• 17th Street levee is breach with reports that 20% of the city is flooded• People continue to arrive at the Superdome despite its being damaged in

the storm• Phone and email out of New Orleans is limited due to flooding, and many

believe New Orleans has “dodged a bullet”

Tuesday, August 30, 2005:• Floodwaters have risen overnight and the city is 80% flooded• Acadian deploys 50 ambulances to the Interstate-10/Causeway Boulevard

intersection and establishes helicopter landing zones and medical triage cen-ter. Helicopters arrive here with rescued victims.

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• Acadian deploys 7 of its air ambulance helicopters to evacuate the most critical patients from New Orleans hospitals. Other air medical transport companies send helicopters to assist in the evacuations. As requested by state administrators, Acadian’s dispatch center begins coordinating and deploying all civilian air medical resources in the affected areas

• Dr. Judice and Acadian medics fly to the Superdome to support and re-place existing Acadian personnel

• Air evacuation of ill and injured patients at the Superdome begins• FEMA activates the National Response Plan to fully mobilize federal gov-

ernment resources• Reports suggest looting is widespread

Wednesday, August 31, 2005:• Massive air evacuation of ill and injured from the Superdome continues.

Population taking refuge in the Superdome now thought to be over 25,000• Air evacuation continues at Tulane Hospital & Baptist Hospital as well as

Touro Hospital and Children’s hospital • Acadian dispatches liaison to Belle Chasse Naval base to assist in air asset

coordination• Twenty-seven (27) civilian and 12 military helicopters assisting in evacua-

tion of medical patients in the city

Thursday, September 1, 2005:• Acadian staff is evacuated from the Superdome due to security concerns• Touro Hospital administrator phones saying he and patients slept on the

roof waiting for help. Acadian sends helicopters• Most of Tulane Hospital evacuated but still working on Charity• Memorial Hospital & University Hospital air evacuation continues• Marc Creswell set up night landing zone at Children’s Hospital• Received call from Meadowcrest in Gretna that there were 120 people still

left in the hospital• Triage center moved from 1-10 and Causeway to Airport

Friday, September 2, 2005:• Evacuations of patients from hospitals completed around 1:00 p.m.• Acadian staff enlists three 18-wheelers to complete evacuation of 48 pa-

tients plus staff at Charity Hospital• Acadian provides ambulance support to FEMA’s Urban Search & Rescue

operation in New Orleans East. Help evacuate forgotten nursing home pa-tients

• Fifteen airlines begin flying refugees out to various cities around the U.S.• Buses arrive at the Superdome to evacuate refugees

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I now respectfully turn the story over to the dedicated EMS personnel. Together, we will tell you in the following pages and in our own words, exactly what we experi-enced during the Katrina rescue and recovery.

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By Air, Land, & SeaOn Saturday, August 27th 2005, two days before Katrina made landfall, New Or-leans Mayor Ray Nagin declared a state of emergency and suggested voluntary evacuation. The next day, as the storm turned toward his city, evacuation became mandatory. By Sunday afternoon Acadian Ambulance was swamped with calls from hospitals and nursing homes requesting evacuations for their patients. Outbound traffic from New Orleans was bumper-to-bumper, substantially lengthening trip times and tying up ambulances in standstill traffic. Additionally, as the storm drew near, the boxy ambulances became unsafe to drive in the high winds. Later, the ris-ing floodwaters made ambulance transport impractical, if not impossible.

The lower areas of New Orleans flooded first, including the Lower 9th Ward and Saint Bernard Parish. Volunteers, along with local police and fire department rescue teams combed the landscape in boats, but air rescue got off to a slow start because military and FEMA helicopters did not arrive on the scene until three days after the storm. The Coast Guard and helicopters picked up the slack from private compa-nies. Acadian’s small fleet worked nonstop, and there were a few National Guard helicopters flying patients from the Superdome to hospitals in nearby areas. But it wasn’t until Wednesday that Coast Guard and National Guard arrived in full force. After that, air-traffic was so thick it was precarious to fly over the city.

Phone calls in and out of New Orleans (504 area code) and Baton Rouge (225 area code) were challenging because of flooding (New Orleans) or the phone net-work being overwhelmed (Baton Rouge). More open lines of communication in and out of Lafayette (337 area code) made Acadian’s dispatch center a hotline for desperate victims of the storm and their concerned family members across the U.S.

**Mike Burney, Dispatch Manager

On Sunday morning, the day before the storm, we got word that Orleans Parish and St. Bernard were going to issue mandatory evacuations. We had maybe 30 units ready to move patients from nursing homes and hospitals, but once we got those patients on board, the streets were gridlocked because there was so much evacua-tion traffic heading out of town. Shelters were opening up in Alexandria, and the trip there normally took four hours, but now it was closer to eight hours, so a lot of our units were just sitting in traffic. They were trying to get patients as far away from New Orleans as they could.

By Sunday afternoon we had more calls than we could actually handle - many from residences with special needs patients who were handicapped or requiring special

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assistance and equipment. Even on Saturday we had residential evacuations calling in, and we were inundated with requests. We struggled to get as many people out as possible, but we had to put facilities, hospitals and nursing homes ahead of the residential calls. We tried to utilize what we resources we had, and put as many people in each unit as we could. At 8 a.m. Sunday morning the Superdome was opened up as a shelter, so instead of taking patients out of town, we started taking them to the Superdome, which initially helped out tremendously. A lot of patients weren't happy about being taken there, but they had no choice at this point. It was the Superdome or nothing.

After a while we started losing more units, because so many were transporting pa-tients long distances to hospitals in central Louisiana. That was about an 8-hour round trip, so that put most of our ambulances out of commission. By 4 p.m. the decision was made to cease ambulance operations and get our personnel and equipment out, because the storm would soon be bearing down on us. In 50 mile per hour winds, ambulances are unsafe because they are box-type modules that can topple over.

By 6 p.m. we had pretty much shut down. Some of our ambulance crews were po-sitioned at hospitals, emergency operations centers (EOC), and hospitals to ride out the storm. And some were at the Superdome, where we had a first aid station set up.

Monday morning the hurricane came through, and the next day, Tuesday, we started hearing about flooding in St. Bernard Parish. I think that's when we realized that they were in trouble. We knew that the levee in St. Bernard broke during the hurricane and there was massive flooding, and we were very concerned about nursing homes that refused evacuation. We were getting reports from paramedic Janie Fuller, who was at the EOC in St. Bernard, that the flooding was pretty bad. At one point she advised us that a Greyhound bus had been parked outside and she could only see the top of the bus because the water had come up so much.

Tuesday morning we resumed operations under what seemed like normal circum-stances, and we were preparing to bring patients back into the city. But now the city was flooded and ground transport out was going to be a problem. Dispatch su-pervisor Mike Sonnier had determined that none of the helipads at the hospitals were functional for various reasons, and we even heard that one of the helipads had been blown off the top of the building, so air transport would also be a chal-lenge. Mike instructed personnel at Tulane Hospital to cut down the light posts on the top level of the parking garage so we could use it as a helipad.

From that point on we started getting hundreds of calls from hospitals with every imaginable crisis on their hands. There was no electricity (some were operating on

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generator power), and there were NICU babies and ventilator patients coming from every hospital, while the water was continuing to rise. I remember one hospital calling to say that they were out of oxygen, out of power and the generator was not working.

On Tuesday we started flying the NICU babies out, and also the vent patients from Tulane, and we told the other hospitals that we'd asked the state to provide us with boats so we could go to the outlying hospitals, pick up patients and bring them to our improvised helipad at Tulane. We worked on that for the next two days.

Mike's idea to cut down those light posts was genius. He is a former Air Med medic and he knew that if he could get those poles down we could use that as a landing zone. That is basically how we evacuated the hospitals. University and Charity hos-pitals were sending patients by boat to Tulane and getting them up to the third floor of the parking garage so we could airlift them out.

FEMA called us on Tuesday to ask that we take over management of the civilian air rescue helicopters. In other words, if another agency such as Miami Flight offered to help out with their helicopters, FEMA wanted us to coordinate with all of those. So we started doing that. We would assign them a mission and they would take care of it and then call back to ask for their next mission. It was going pretty well at that point.

Flight paramedic Marc Creswell was coordinating that at Tulane, and at one point a FEMA representative came up to him and said, "OK, we have it now, and we’ll take over." So we turned it over to them, ceased our operation there and moved Marc to another location. We were dismayed to hear later that after we left, things kind of shut down in terms of a continuous flow of patients.

We'd been also taking patients to the airport, where they were scheduled to get on C-130s and fly off to various locations. But the babies, being NICU babies, flew straight to Lafayette Women’s & Children’s Hospital, and some to Baton Rouge. That went well when we were doing it by ourselves, but when FEMA came in, there was another slowdown, according to some of the hospitals. It just wasn’t moving fast enough.

By Thursday morning, day four, we were still trying to get patients out of hospitals, but we had to also start evacuating our own personnel from the Superdome be-cause it was no longer safe for them to be there. I got a call from one of the guys at the Dome, and I heard the urgency in his voice. He said, "Come get us out of here because it isn't safe." We had Air Med 1, 2 and 6 at our home base in Lafayette, so we sent them to move our people from the Superdome to a field hospital we'd set up on Interstate 10 at the Causeway off ramp.

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**Jay Boudreaux, Paramedic Dispatcher

We made a couple of unsuccessful attempts to get to the Superdome by ambulance to drop off supplies on Tuesday, but the water had risen and was continuing to rise. As we were driving through the city people on every corner flagged us down. I had a patient to transport, and we had to figure out if there was an open hospital any-where, which was a challenge in itself because there was no radio communication. We took a stab in the dark and went to West Jefferson, and they were open.

Patients were being evacuated by boat and being brought in by helicopter and emergency vehicles. They did have some ambulances transporting to the triage area at the I-10, but the majority were coming by military aircraft. The on ramp there at the I-10 and Causeway is a cloverleaf, so they were landing on the cloverleaves, and the ambulances were frantically unloading the helicopters one right after an-other.

Tuesday night paramedics, Henry Rivet, Todd LaPorte and I tried to get back to the Dome with medical supplies. We drove a rental truck that was much higher than an ambulance and could drive through the water. We got within three blocks, but then we couldn’t get any closer, because if the truck stalled then we would be forced to sleep there, and that wasn’t a good thing. So Henry and Todd decided to put the supplies, including hamburgers cooked at the Gretna station, in an ice chest and float them over to the Superdome. I waited in the truck, and that was the longest 40 minutes of my life, sitting in the middle of flooded Tulane Avenue in the dark with no idea of what was going on in the city or when Todd and Henry would come back.

Thursday morning, I went out to I-10 and Causeway, but then Erroll called and asked me to go to the Superdome to coordinate with the military to evacuate pa-tients. One of the Air Med helicopters flew me in. So I went to the heliport to coor-dinate with the military. Those guys take care of their business really well, but they weren’t getting adequate information about where their helicopters were needed. Those guys evacuated a lot of people eventually, but early on they weren’t doing much because they just didn’t have the information. Working with the military was interesting, and they did a really, really efficient job once we were all on the same page.

On Thursday, along with the hospital evacuations, we evacuated 130 medical pa-tients from the Arena, and when I got back there Friday morning, I heard 200 more had come in during the night, as overflow from the Dome.

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One of the big challenges was that the hospitals in the downtown area don’t have heliports. Normally when we transport to those hospitals, we land at the downtown heliport and take an ambulance the last four or five blocks, but this wasn’t possible because of the water. At one point we ended up converting the top floor of the parking garage at Tulane hospital into a landing zone by tearing down the light poles. From there we were able to get patients from Charity Hospital, University Hospital and the VA to the top floor of the Tulane parking garage and fly them out from there.

**Marc Creswell, Flight Paramedic

Prior to the storm we got a request from Renaissance, a nursing facility in St. Ber-nard Parish, to evacuate their patients. We flew eight or nine people to Yazoo City, MS, and left there when the winds got to about 40 miles per hour, and it was a risky maneuver trying to get out of there in those winds. We dropped the aircraft off in Alexandria to secure it for the night, and a fixed-wing aircraft brought me back home to Lafayette.

Tuesday morning we found out about the flooding and everything went crazy. That's the day that we ended up pulling down the light poles at the top level of a parking garage at Tulane to make a landing zone. This helped us get their critical patients out quickly, using mostly Acadian aircraft, and it wasn’t until much later that we got any help from outside agencies. We kept on flying and flew quite a bit of the night and I bedded down there at Tulane.

We went to Children’s Hospital the next day, and then to Memorial Hospital to evacuate more people. We were taking patients in droves, with no destination hos-pitals assigned, no charts, no reports… we were just grabbing people and taking off with them.

By Thursday morning we finally had some military help, and we worked our teams to death, made double time everywhere. I ran those nurses and doctors into the ground, but we managed to get people out fairly quickly. We must have turned over 50–60 patients, just bringing them all over the place.

I was called to go to a hospital called St. John’s, which was a long-term acute care facility, and it was a really desperate situation. They were flooded and had been out of power for a while, and there were nothing but women there. There was only one guy – a security guard with no medical knowledge, and he had a handgun for secu-rity. They had 27 patients and 11 or 12 deaths, and the bodies were stacked on the first floor.

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Later on I was summoned to Meadowcrest, which is a hospital toward the eastern part of Orleans Parish. They had just started evacuating people and were desper-ately looking for someone to lead them out of there. We found out how many they had, where they were going and what they needed, but we didn’t have a landing zone there.

This was one of those times when we had to improvise, so we found a parking lot across the street that had a bunch of trees in it, and I managed to find a tree saw. Cody Schuff, a couple of other guys and I worked together to cut all those trees down -- probably a dozen of them -- in about 30 minutes. We were wearing our-selves using a handsaw, and after about 20 minutes, a guy from a utility truck comes by with a chain saw and offers it. He said, “I’ve been watching y’all struggle with that hand saw, and thought you might need this." He got there as we were cut-ting the last tree, and we had to wonder why he stood there watching us for so long before coming over with his chain saw. Anyway, we cleared the whole place out and made a night landing zone area.

We lit the place up like a Broadway show, and things really started picking up. PHI was dropping four helicopters on us about every 40 minutes. Blackhawks, Hueys, you name it. Every known aircraft was in and out of there till about 11:00, until it got too foggy. After the fog came in, we started trucking those people out of Mead-owcrest. We had six heavily armed guys from the Jefferson Parish Sheriff’s Depart-ment for security, and a dozen ambulances.

The staff at Meadowcrest had emptied out their freezers because there was no elec-tricity, so they took all the meat out and put it on ice. So here we were working like mad, and suddenly the hospital staff gives us all this meat: pork chops, tenderloins, chicken and sausage and what not. There was a guy named Captain Mike from La-fayette who rigged up a barbecue and started cooking for us, and he brought his own brand of seasoning. If you ever hear of Captain Mike’s seasonings from Lafay-ette, go buy it, because it is the best. I swear I ate so much barbecue I thought I was going to turn into a Texan.

I found a bed in the Meadowcrest emergency room and slept there. Woke up the next morning to the smell of barbecue, so I engorged again. The name of the game in New Orleans during this whole time seemed to be that if you see it, you need it, you take it. You don’t take a whole lot, just what you need, eat as much as you can when you can, drink as much as you can when you can, because you don’t know when you will get any more.

After that we moved on to evacuate patients from the Superdome and take them to the triage station at the I-10, and this was probably the worst scene I saw the whole time. It was five days post-hurricane, and people were in really bad shape. The

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people that were going to die had died. The people that will die, were dying. The smell was just unbelievable. People crying out for help, and there were a lot of people that were psychiatric cases. It was unbelievable. You always see this kind of stuff on TV, so you don’t really think that something like this could happen in your own world.

We got all those patients moving and – this is the biggest thing – FEMA is so bu-reaucratic! You got to get names, got to get this and that, and these patients are dy-ing right dead in front of you, but FEMA wants all these little things. We didn't have time for all this bureaucracy.

I came back home because we ceased air operations during the day, and I got a good shower and slept in my bed. Did not sleep really well because I was still spun up, and woke up real early the next morning and went straight to the commu-nications center, packed a bag and went back out to the airport and did it all over again. Stayed there most of the day and turned over patients real rapidly. Dr. Ri-cardo Martinez had lots of connections and he was great, and even if he did not have many connections, he was very well motivated.

You know, my military roots come to play here. I kind of call it like a forward air controller. I just kind of got on scene and figured what we had, where they were going, how much resources we needed, and how long we were going to be there. We just went rooftop to rooftop to rooftop for eight or nine days.

**Dr. Ross Judice, Medical Director

At one point while I was at the Superdome helipad coordinating the evacuation of patients from the Arena, some military trucks showed up with orders to bring the vent-dependent patients from the VA Hospital being bagged over to the Dome to have them flown out from there. Because they were most critical, we temporarily halted the evacuation of the DMAT patients. The PHI helicopters took the first four patients, one at a time (they only are configured to carry one patient), and we had no way to evac the last two because the pilots had maxed out their hours and couldn’t fly anymore.

I remembered that I’d seen some National Guard Blackhawks flying in and out with supplies earlier, so I went over to where they were stationed and asked them to fly these last two patients out. The guy said, in a snotty way, “Yeah, we’ve been watch-ing you fly them out on those PHI helicopters.” I was shocked that he’d just been sitting there watching us move the patients one at a time when those Blackhawks could have taken them all in two trips. I didn’t want them to know how angry I felt,

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because I really needed them to fly these bagged patients out, so I asked him nicely and he agreed, but he complained the whole way.

That was Tuesday night. Later on it got quiet in terms of flights, and I went into the Dome to be a doctor again, thankful to be doing what I know best instead of direct-ing evacuation operations from the helipad, which is what I’d been doing for the last 12 hours.

Wednesday morning, to our great relief, a zillion helicopters showed up, all types, civilians, military, Coast Guard, and National Guard. It was probably the largest air medical evacuation ever within U.S. borders. That’s when things started getting really chaotic, because more people were getting sicker and sicker in the Dome...people without their meds, babies being born, dehydration, strokes, you name it. We’d load people onto a Blackhawk, it would lift off, and the a civilian helicopter would land, we’d load it up, it would lift off, then a Coast Guard helicopter....it went on and on like this for hours, all day Wednesday into the early evening.

We’d shove people into those helicopters so fast that our communication system just fell apart, there was no taking names, no paperwork, nothing, just throwing people into helicopters and getting them out of there. There just wasn’t time. I re-member writing down the names of the first three patients on the PHI helicopters, but after that, there was no way. There just wasn’t time.

I had one guy who’d had a stroke in the Dome, and he had a large extended family with him. I put him on a helicopter, which has no room for extra people. The family flipped out because they couldn’t go with him, and I had to call the MP's to push them away. We couldn't even tell them where their daddy was going. Most of these patients were being dropped off at the I-10 cloverleaf to be put into ambulances and taken to various locations, but we had no idea where those locations might be. And plans changed all the time. Even if they went to a particular hospital, they’d often be transferred, so families were always being separated, and this happened to hundreds, maybe thousands of families.

**Remi Judice, Nurse Anesthetist

On Wednesday at the Superdome, helicopters would come in groups. In a 45-minute span you might get 10 or 15 helicopters landing. Then at other times, we’d have long dead periods where we wouldn’t see a helicopter for 30 minutes. If we weren’t careful we could have a whole bunch of sick people in our staging area near the helipad in the middle of a hot summer day, and have to treat them when we didn’t have many supplies and no way to evacuate them. I was frustrated when

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there were no helicopters coming in, and walk over to the heliport and say, “Do you know if any helicopters are coming?” And the guy would say, “We have 2 get-ting ready to land. Get your patients ready." And I’d say, “When?” And he’d say “In the next 15 minutes. Get ‘em down here."

So we’d get ‘em down there but the helicopters wouldn’t land for another hour. So we’d have sick people just sitting there waiting in the hot sun with one little tent over them. Then finally a helicopter would come, but would only take certain pa-tients. They'd say, “We want eight people that can walk.” Well, those aren’t the sickest people, the sickest people are the ones that can't walk...they're on the stretchers, and at some point there were National Guard and civilian helicopters that wouldn’t take any stretcher patients.

Somewhere between 3 and 10 p.m. there were helicopters coming in, and we couldn’t fill them fast enough. They were anxious to land and leave, for one reason probably fuel, and another reason they probably had other missions to do. There were obviously two different agendas for the helicopters...one was to evacuate pa-tients and the other was to transport supplies. I was just involved with the evacua-tions.

At one point I called the DMAT area to bring out some patients for evacuation, and we were able to evacuate everybody. It was a race against time to get patients from DMAT to the helicopters. The DMAT person would tell me he had two walking wounded and one stretcher, and I'd say, “I don’t care what they are, I want as many people as you can send.” And he would say, “I found two more stretcher patients, and we’re sending you six walking wounded.” And I'd say, “Send ‘em all.” I wanted to make sure no helicopter was left unfilled. We were putting people into helicop-ters as fast as we could, not writing down their names or knowing where they were going. After a while it slowed down to a crawl, and eventually in the late evening around 9 p.m. there were no more helicopters flying and we just took care of pa-tients in the dark.

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Life and Death on the Interstate: The I-10 and Cause-way Cloverleaf With most of the city flooded, there were very few safe, accessible places to set up medical treatment stations. However, parts of the interstate freeway system in New Orleans are elevated above ground level, and since the freeways were empty and abandoned, a section of Interstate 10 at the Causeway Boulevard off ramp turned out to be an ideal location for a triage area. We set up this station on Tuesday. On Thursday, when we had to leave the Superdome because of safety issues, the I-10 became our center of operations. The on and off ramps were in a cloverleaf con-figuration, so the helicopters could land on each of the four “leaves.”

There were an astounding number of patients. Helicopters, ambulances and boats were constantly unloading evacuees. There was insufficient security or transport to handle the mass of people, estimated to number around 5,000. Although the triage station was for sick or injured people, the general population sought refuge there as well. A barricade separated the triage station from traumatized people who’d been displaced for three days or more, and were without food, water, and shelter or toilet facilities. As elsewhere in the city, there was fear everywhere.

A triage station is where medics determine the patients’ needs, and then prioritize them according to which ones need help first. In triage, medics use a system called “tagging” in which patients are identified by different colored tags:

• BLACK - This person cannot be saved given the available resources and re-quires only support and pain medication until death occurs

• RED - Immediate life threatening injuries that must be treated at once• YELLOW - Non-life threatening injuries that are a lower priority than red

tags• GREEN - Minor injuries, also known as “walking wounded”

The walking wounded initially were sent away and not treated so that the severely limited resources could be used for the red or yellow tags. If a patient was judged unable to survive they were black-tagged. Turning away the injured was a reality check, especially for those who were trained throughout their careers to respond with immediate care.

All were wounded or emotionally traumatized in some way, including our own medics, who had never experienced a mass casualty event like this one.

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**Jeff Thibodaux, Paramedic

I can tell you that spending 16-18 hours at I-10 and Causeway evacuating people coming in on Hueys & Blackhawks and Chinooks and the Coast Guard was a sight to be seen.

We got there Tuesday at probably about 2 p.m. and left Wednesday morning about 9 a.m. It was just a mass of people coming in from all over New Orleans. People had been picked up off of roofs and cut out of attics. As soon as they came off of the helicopters they would hug us and say, “God bless you,” because they were so happy to be safe on dry ground. We’d escort them toward the I-10 where we had a triage center set up. If they had a medical problem we would run them through tri-age, and if not, we’d put them in general population across the median and just wait for school busses to evacuate them. Needless to say it was a scene...people coming without shoes, without shirts, ba-bies with no diapers. It was unbelievable.

**Gifford Saravia, Paramedic

The day I went back to the Superdome they told us our medics had left because it wasn’t safe to operate there anymore. We were redirected to Causeway and I-10, and our first impression as we flew over was that it was a litter-strewn nightmare. There was a big old glob of people on one side of the road and the triage area on the other side. When we landed, there was trash all over the place. It was raining. The medics were working in the rain.

**Dee Dee Sewell, Paramedic

At the I-10 and Causeway triage station, I saw patients lying on cots and on the ground and on the street. Some people were able to get on the buses, but then there were the others, just rows and rows of people laying out on the ground, old people, sick people, bare pale wrinkled skin on the hot concrete pavement – no cover sheets, no pillows, just old, sick people laying about on the roadway. I saw people in shock, people sleeping out in the open in the middle of the day, just as far as you could see. I saw people holding babies with no diapers, and they had no bottles to feed the babies with. They hadn’t had bottles since the storm and the ba-bies were weak and listless. The women sat fanning the babies with anything they could find to use and the sweat was dripping down their own faces.

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When I got to the triage station, it was chaos. The medics and volunteers were run-ning around asking, “What do you want me to do, what do you want me to do?” and the people in charge were being pulled in a million different directions. There was a whole line of ambulances waiting to take people to safety and a bunch of buses to take the wheelchair patients, but those vehicles were sitting there because nobody had given them any orders. One of the doctors was very frustrated and when I asked him what was the holdup he told me, “The patients have been tri-aged, but nobody seems to have the authority to put them on buses and send them on their way.” I asked, “Where would they go?” And he said, “They'll go to the air-port where a field hospital’s been set up. They’ll get some care and be evacuated out.” I asked if he was sure about that and he said he was, so since nobody else was around to make the decision, I just hollered, “load ‘em up!”

The ambulances were from all over the place, they were not just our ambulances, and they were so happy to finally be doing something. I’d go up and say, “put these two on this ambulance, put these two, take these two, line up all those wheel-chairs, get them over there on that bus,” etc., and it worked really well. In a fairly short time we had that place cleared out so that the next group could come in. And they did… they just kept coming and coming and it seemed that as fast as we moved some out there were twenty more to take their place.

There was a doctor from Tulane who was sitting with an elderly lady. I didn’t know he was a doctor at the time; I thought he was a family member and it was obvious that he was one of the evacuees too. She couldn’t really speak, she was just so de-hydrated, and the doctor stayed right with her. He called me over to her cot and asked “Is there anything you can do? She needs to get out of here. She’s dying.” I told him “She’s on the next ambulance, she’s next.” I got a crew and we were able to get her out and he thanked me and gave me a big hug. I asked if that was his wife and he told me, “No, I’m a doctor. I knew she was dying and I didn’t want her to die alone; nobody should have to die alone.”

**Steven Hamilton, Paramedic

Triage was not as easily done as one might expect in this type of situation. As paramedics we’re used to treating a problem immediately. If someone is complain-ing of weakness, we put him or her in an ambulance, start an IV, and take it from there. That was the mindset I had when I first started triaging the people who were walking up to us. But then I had to take a step back and realize these people are walking up to me - these are green patients, and they’ll be OK on their own for a while. I need to send them on their way so I can take care of the more critical peo-ple.” And that’s what we did, managing these patients according to Acadian triage protocols.

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I did that for about four or five hours, maybe a little longer. You know, people com-ing off the helicopters were thanking us for what we were doing. They were so grateful, even though they’d lost everything. And for the most part, a lot of them were in good spirits, while others were not. I had one lady trying to get back on a helicopter to go back to her house to get her meds. You could just tell from that point that these people were just lost. Their minds were gone.

**Gary Miller, Distribution Supervisor

We went to the Causeway to bring the medics some food and supplies, and once we were there, we assisted the medics with their patients. Of course the medics tri-aged the injured and ill. There were rows and rows of people along the interstate underneath that overpass waiting to get out of there. There were so many who needed help, and they were just spread out all over the place. Some we thought were sleeping, but actually they were probably dead.

**Richard Pellerin, Paramedic

Wednesday, probably around 11 in the morning, I made it out to the triage station at the Causeway and I-10 where there were 750 to 1,000 refugees, but it’s really hard to estimate. There were probably four helicopters landing at a time, dropping off additional evacuees.

Acadian had ambulances there, as did other transport services. We were loading patients into the ambulances, one stretcher patient and as many as 5 or 6 ambula-tory patients. We’d squeeze them in there, as many as we could to maximize our space.

People were coming in by ambulance that had been pulled out of the water, and we were getting boats as well, so the number of refugees was just mounting and mounting and it got to the point where we were less efficient because there were so many people. Communication was an incredible problem at the Causeway and I-10. One of the biggest problems we had was our medics not staying with their ambulances, and we did not have radios to contact them. So I was constantly grabbing ambulances and putting them in line and sticking medics in each ambulance to transport pa-tients out. I had no idea who was going where or which medics were with which ambulances.

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I tried to keep families together if I could, and I had to convince people that only one family member could accompany a patient. There were a few instances where a mother and father and 2 kids were all they had, so I made exceptions for them. As far as personal belongings, we did our best to keep everything together realizing that what they carried with them was everything they owned in the world.

**Jay Pierret, VP Business Development

As we approached the city it was drizzling, and as we flew over, we could see how empty the city was. Then we approached the I-10 and Causeway.

We could see all thousands of people waiting in line. The ambulances were lined up, along with military trucks, ambulances, backhoes and all types of heavy equipment scattered all over the place. We got in and obviously there was no clear organization to it, there was a line of people that were wet and getting rained on, so I tried to help them as much as possible, trying to clean up the place, move the trash out the way, etc. But then we got word that we were going to move to the New Orleans airport; so we had to pull out all of our ambulances and coordinate from there. We did it as discreetly as possible so we wouldn’t freak people out and make them think we were abandoning them.

**Jay Boudreaux, Paramedic Dispatcher

Wednesday morning I went out to I-10 and Causeway, and worked there all day. I helped with communications. That was the day it began to get out of control. There wasn’t enough security, and several times I called Terry back in Lafayette on the ra-dio and asked him to try to get either more security or more buses to get people out of there, because it was getting pretty scary. I’d guess at one time that there were 5,000 people waiting on rides.

We had no portable toilets, and no food or water. At times we had surplus water that had been dropped off by military aircraft, but it had been baking in the sun for several hours, so it was warm...actually, hot.

It seemed that initially that the triage area was working well, and at certain points the military aircraft would be slow to return with patients, but those guys got to be pretty efficient and there were always enough ambulances. But to me, there should have been more buses to get people out because we had 5,000 people who’d been without food or water for three days.

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Helicopters would come and go. They would land from the north and depart to-ward the south. They got into a traffic flow pattern and landed, dropped their pas-sengers and took off. There was no traffic control at all, but most of the aircraft was military and they were communicating amongst themselves.

**Mark Fryou, Paramedic

We drove our ambulance on the elevated interstate highway to an on ramp down-town to try to help evacuate some ventilator dependent patients. They were report-edly being evacuated by boat from one of the hospitals. While waiting for the boat to arrive, a truck pulled up with about 4 men in it. They hollered at us to come and get a body out of the back of their pickup truck. We told him we had no place to bring a dead body. We said that we were waiting for sick patients to arrive and that we couldn’t risk transporting the body while leaving the patients without an ambu-lance. Three guys and one woman got out of the truck and they put the body on a piece of plywood, covered the body with a sheet and put him on the ground. They sat next to the body.

We flagged down a state trooper and explained the dilemma of the body on the ground. As it turned out, the lady sitting next to the covered body was the deceased man’s wife. The trooper made a couple of calls on the radio and began to leave. He said that the coroner’s office advised him to leave the body there. Now obviously this is the thing to do in that type of situation, but it’s quite different realizing that this woman not only lost her husband, but now she doesn’t have the vaguest idea how to deal with the body. Under the circumstances, there’s really nothing more that we could have done without wasting a bunch of resources. It was very sad.

A female approached us with her leg wrapped up. She was beaten up because she didn’t get off a pay phone fast enough. Since she didn’t have any life threatening injuries, we advised her to catch a military vehicle and go to the Superdome five blocks away.

Later we made our way to the triage at I-10 and Causeway. They had a large num-ber of evacuees on the left side of the triage area awaiting bus transportation, and even though this was only mid-afternoon on Tuesday, the atmosphere was chaos, and you could feel the tension in the air.

We loaded up with three patients, one in the front of the ambulance, one walking wounded in the back and a ventilator-dependent patient from the VA that had been taken to the Superdome by National Guard truck and then flown over to the Causeway for ambulance transport.

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I gave him some Versed because this guy was bucking the tube and we transported him to the P-Mac in Baton Rouge only to find out that once we got there, he was black tagged by the physician there.

At the P-Mac, there was a patient flown in by military helicopter who was intubated and had gunshot wounds, and they black-tagged him also. So recognizing (but not necessarily agreeing with those decisions), we realized this was a waste of our re-sources as well as the helicopter’s resources by flying in all these patients who were ultimately being black tagged.

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The ChildrenHuman values dictate that the most vulnerable in any population must also be the most protected. Parents and nurses entrusted their precious babies to our care even though we were strangers. Placed in makeshift water boxes instead of incubators, sick babies were flown out of the devastation to hospital destinations unknown.

Pregnant mothers delivered their newborns at the Superdome and Arena. Medics fashioned baby “bottles” with rubber gloves for desperate mothers. Baby formula and diapers were flown into the city along with medical supplies and personnel.

Through it all our medics displayed so much love and caring toward the children.

**Marc Creswell, Flight Paramedic

They called me to go in to Children's Hospital to clear out a landing zone. We got that set up and met with the director of nursing, who was under the assumption that we were going to do this nice and pretty like we always do, taking our time and carefully putting one baby into each helicopter. I told her that this is a third world country now and we have to move in high order, and we have to do it now. She thought we were going to put one baby per isolette per helicopter, but we wound up packing 4–6 babies in Kentwood water boxes, wrapping them up and shoving them in to the helicopters. Talk about improvising! I managed to find several Ken-twood water boxes that were meant to hold two one-gallon jugs of water. We knocked out the middle portion, shoved a bunch of blankets into it and we put the kids in there.

Meanwhile, the New Orleans airport quit taking patients because they were full. They filled that makeshift field hospital with so many patients that they were putting people on the baggage carousel, and they just couldn’t take any more. This was Wednesday. So because we couldn’t bring patients, we went to New Orleans Chil-dren’s and picked up those kids and brought them to places where we knew we could bring them. I think we got 16 or so out. We organized an effort with Miami Children’s Hospital and Arkansas Children’s, which both had helicopters. We just threw a bunch of helicopters at them real quick and got all of them out of there in just a couple of hours.

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**Tony Cramer, Flight Paramedic

Our initial purpose was to get a lot of babies out of there. We landed at Tulane and all we could see was the level of the water rising. Tulane had a huge generator, and people were saying, “As soon as the water gets above the trailer, we’re going to lose that generator and lose all power.”

The thing that got me the most was the parents asking if they could come along with us, with their babies. Of course, we had no way to move these parents; there just isn’t room in the helicopters. These poor people had to leave their brand new babies, but they understood and said, “Whatever happens, just save our baby." We finally got the babies ready to go in the isolettes, but when we got to the elevator, it no longer worked. So we had to get a bunch of people and start packing these iso-lettes -- which are 6 feet long and weigh 300 lb. -- up three flights of stairs to get to the helipad. You can’t imagine how difficult that was. But we managed to do it and we loaded them up and got the babies to Women’s Hospital. The support group there was fantastic.

It was required eventually to abandon the isolettes. We ended up with two nurses on board, each holding a baby, and 3 and 4 other babies on stretchers.

**Clay Henry, Vice-President of Dispatch

I believe it was either Wednesday or Thursday night after the storm, we had an Acadian helicopter lift off with a team and a critically ill child. They landed at the refueling site only to find that the fuel tanker had been pulled out of there without notice. So the helicopter was grounded, and the team was extremely upset. They even got on the phone and yelled at us, thinking somehow it was our fault. So after some re-assuring that we were doing everything we could to help them, we dispatched a ground ambulance, which took about 20 minutes to get to them. It was all we could do, because all our other helicopters were either too far away or had patients on board.

The baby ended up going into cardiac arrest on the side of the road at the weigh station. The ambulance got there, loaded up and began transport towards Baton Rouge. The team on the ambulance evidently resuscitated the baby. I don’t know the patient’s outcome, but it was supposedly pretty grim. There was probably about a 30-40 minute delay of not being in the air because of lack of fuel.

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The next day I asked Erroll for an explanation and he said that somebody with FEMA had pulled the fuel tanker out of there, thinking it wasn’t going to be needed. It was clearly a mistake on their part, and according to Erroll, it was put back some time the next day. Our helicopter ended up being grounded the rest of the night because we couldn’t get fuel. So that particular shift ended up being out of service for eight or nine hours on the night we were taking the infants out of the hospital.

**Jay Pierret, VP Business Development

At I-10, Acadian paramedic Robert Clement was holding these two little girls that had been abandoned; actually they were part of a group of seven children who'd been left on a rooftop. He was quite attached to these girls. He said that people from the crowd were offering to take the babies, but he wasn’t giving them up. He was very protective and showed how much caring the medics have for children. He was making sure that these kids went through the proper channels and weren’t just handed over to strangers. He was holding two of them and eventually gave one to another medic, but the girl was quite attached to him. I had some candy so I gave some candy to her and some of the other kids.

**Gifford Saravia, Paramedic

After the evacuation of the medics from the Superdome we were redirected out to Causeway and I-10, and it was raining. The first thing I noticed when I walked up was that there were several medics just holding babies, mostly toddlers. There were seven of them, so I asked one of the medics, Rob Clement, “What are y’all doing?” He said that a Blackhawk had landed and all of these babies came out, but there were no adults with them. Nobody knew their names, where they were from or who they belonged to, so they had the media photograph them to post on some type of internet bulletin board to try to get them paired back up with their parents.

Greg Mullen informed me today that he heard the parents were actually in San An-tonio, had located the babies through that bulletin board, and babies were flown out to San Antonio to meet them. They’ve all since been reunited. This one was a happy ending to a possible disastrous story.

**Kimberly Lewis, Paramedic

We transported little kids that were separated from their families. Getting these women off the helicopters with their children was so sad, not knowing where the rest of their family was, and having just one bag of clothes and one bottle and some

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diapers, it was sad. There were a lot of children like this, especially at the Cause-way. It was really confusing. Everyone was separated from their families and we were just putting them on the buses telling them, “You’re going to meet up with them, don’t worry,” and it broke my heart because I didn’t know if that was true.

I’m not a mother yet, but I can only imagine what it would be like to lose your kids and have all of your belongings gone in one day. These little kids, you know, they didn't know what was going on, and it was really hard to see them. Of all the things I saw, that made me really want to cry. But I’d do it all over again in a heart-beat.

**Steven Hamilton, Paramedic

About 10 p.m. Tuesday night, Brendan had us head over to Oschner Hospital to transport six patients to Baton Rouge. These were infants coming out of the NICU. Two of them were in isolettes and one was intubated, so they needed to be moni-tored. Justin Abshire and I got in one unit and headed to Oschner. Brant Duple-chain and a nurse practitioner from Baton Rouge Women’s and Children’s loaded into another unit also headed to Oschner’s. Once we got there we noticed that the hospitals didn’t have any electricity and were on back-up generators. The nurses were in good spirits though. They were wearing shorts and t-shirts trying to stay cool, but were frantically taking care of these infants and newborns.

**Remi Judice, Nurse Anesthetist

Around, I’d say 6 p.m. on Wednesday, we were told that the staging area was full and there weren’t any helicopters coming back to the Superdome. The DMAT team called and said they had a 5-day old that was sick and severely dehydrated and needed immediate evacuation. It just so happened that some privately owned heli-copters were coming in, and when they landed, I told the pilot that we had a 5-day old that needed immediate evacuation. He said he wouldn’t transport that baby un-less we had a neonatal specialist on the helicopter. I guaranteed that we had a paramedic trained to do that, and I said I would go along too, since I’m a nurse anesthetist, but he still said, “No, I want a neonatal specialist." He was very em-phatic, so I went and found one (or what the pilot thought was one), which was really an anesthesiologist named Scott Gammel. After speaking with Scott upon my return the next day, Scott told me that he had the baby flown in to Women’s and Children's Hospital in Lafayette and that the baby was doing fine.

I was told that outside the Superdome some of the looters overturned a boat with a very young baby less than a week old in it, and the only thing that came back up

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after they flipped the boat back up was the baby. The medical teams revived it, and we heard that the looters ended up shooting two civilians, but didn’t shoot at the medical personnel.

The baby was brought into the Arena and they needed to get it evacuated and wanted to send a physician along. But the physician on duty didn’t want to leave the staging area, so he set up an impromptu 100% oxygenator and we got an 02 meter, an oxygen tank, a cup and a piece of tubing. We put the cup over the in-fant’s face and rigged the tubing to flow oxygen into the cup so the baby could breathe 100% oxygen.

Then the FEMA doctor asked to borrow my stethoscope. I looked at his name, and asked if he was going to be making a round trip, and he said yes, he’d be back later on tonight. So I gave him my $125 cardiology stethoscope to take along with him, which I felt was a good investment in the health of the baby. He took the baby to the helicopter and I never saw him -- or my stethoscope -- again.

**Dr. Chris Najberg, Emergency Medicine Resident

Sometime around 9 p.m. on Wednesday at the Superdome there were five women in active labor. They all came in almost at the same time.

At that time there were also two very sick infants, both under 6 months old, one of whom had pneumonia and was and very lethargic and had sunken membranes. At the time, one of the pregnant ladies -- about 8 months -- had a history of placenta previa, according to the documented diagnosis, but she also appeared to be in ac-tive labor, which presented a serious problem, as she would have required a C-section and almost certainly would have died. Dr. David Bryant was able to arrest the labor by giving magnesium and 3 liters of normal saline. We had to get this pa-tient out as the highest priority, as she might not survive the delivery. So Dr. Chuck Burnell and I were able to arrange a transfer using a Blackhawk helicopter within about 20 minutes. I went with the patient myself and took some basic supplies, should the worst case scenario happen. However, thankfully it did not, and I was able to get her to Baton Rouge where we dropped her off at Women’s Hospital.

**Dee Dee Sewell, Paramedic

The buses came back to pick up more patients, so we went down the row of people that were lying on the ground to get them into the buses and evacuated out of there. We found two women with six children, but only two of the children were theirs, and they said, “We can’t go.” They were desperate. I said, “You need to go,”

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and they said, “We’re waiting for more people, for the family,” and I said, “You can’t wait, the buses are here, you need to go.” And they said, “But you don’t un-derstand, these are not our children. They just gave them to us when we evacuated the Dome and they said don’t get separated from these children. We don’t know who they are, they’re not ours.” And they wouldn’t leave.

It was getting hotter and hotter outside and the babies were tired. The next thing I knew I saw those children at the triage station, and the women had finally just left them there. They couldn’t take them and they couldn’t do anything with them, so they left them at triage. We made a cardboard box as a bed for a little one that looked to be about five months old. I looked around in the rubble and I found a lit-tle bag that someone had left with two baby bottles in it. We washed those out as best we could and fed the babies. Then we gave the babies to some volunteers that were there to help feed them and take care of them.

Last night when we were coming back from New Orleans, we were just drained, I mean we were exhausted. We were talking about how emotionally draining it had been and the effect it would have on the people for years to come, and then we got paged on the pager. This was a miracle, because our phones hardly ever worked. Between us all we had six phones and it was a constant scramble to see who could find a signal, but for the past two hours we’d had no phone capability at all. So here we are, leaving New Orleans, finally and the pagers worked. It was an urgent page to me from Keith Simon, in PR. He said that he’d heard from Maria Placer with Channel 10 in Lafayette that a mother had been found here in Lafayette who had been separated from her 10 month-old baby back in New Orleans. They wanted to know if we’d be willing to go back and get the baby. Well, we couldn’t turn around fast enough, I mean literally, we were in traffic bumper-to-bumper, but we made a u-turn right then and there and went back to get that baby. We had a little trouble finding the neighborhood, but with dispatch’s assistance, we got there. The neighborhood had hundreds of houses with missing roofs, missing windows and trees down in the yards, but thankfully, the streets were clear and we could get through.

We found the little house and there were four people outside with this little child named “Destiny”. Her grandfather was sitting in a wheelchair and was looking very fierce and worried as they handed over their baby granddaughter to a group of total strangers. We told them that we would take very good care of Destiny and would keep her safe and bring her back to her mama in Lafayette.And so we did, and she was absolutely adorable. She had great big eyes and just the cutest little smile and for some reason she seemed to just take right to me. I think I can speak for us all when I say it was a huge, huge honor to us for that fam-ily to trust us and let us be a part of taking this child to her mother.

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Dianne teased me because it was my grandson’s first birthday and I was really miss-ing him and wishing I could be there to celebrate his birthday. She said I was over-due for a dose of “baby holding”, and she was right. I held that angel all the way home. When we got to Lafayette we found out that the mother did not know we were bringing her child back. When we came in she was so excited! As it turned out, she was in the hospital at the time of the storm -- in labor having her second child -- and Destiny was with the grandmother in New Orleans. Then somebody brought in this absolutely beautiful newborn baby...Destiny’s new little sister! Eve-rybody hugged and cried, and it was just a perfect ending to a really horrible past five or six days.

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The EldersIt is impossible to look through these stories and decide which group of survivors has the most horrifying stories. In the case of the elderly, it is particularly heart-breaking, because many of the nursing home residents had already been separated from their families and were living out their last days alone. Many sick elderly res-cued alive from the flooding were alone and confused, and were rushed to safety by well-meaning rescuers. Without their medications or their caretakers, they relied on our medics for comfort and care.

**Jay Pierret, VP Business Development

Friday, while on a Search & Rescue operation in New Orleans East, two men walked up and asked us for water. We gave them some water, but we didn’t have any MREs at this time, so we couldn’t give them anything to eat. They said, “Hey, we’re okay, we’re doing fine, but you really need to go to this nursing home cause there’s old people out there and they’re dying.” He said we needed to get over there and take care of them. They told us it was just down Chef Menteur Highway about 3 or 4 blocks.

I transferred that information to the FEMA people via the yellow radios they'd handed out to us. There was a lot of radio chatter about it and eventually the search and rescue teams were deployed. They found a Catholic nursing home with a nun running it, and she was still there trying to help people. The medics that came back from that mission said that she deserved a medal because of how she had it organ-ized and how many people she saved. I believe somewhere between 15 and 20 people were already dead; we evacuated 57.

The medics did a fantastic job of getting those people out. The search and rescue guys were unbelievable. They grabbed the patients and brought them down the stairs, because all the patients that were alive were on the second floor, so they had to be carried down the stairs. Initially they started putting them in ambulances two and three at a time, bringing them to the staging area or the triage area and having the doctors work on them. Then Dr. Judice in the FEMA operations center called in the helicopters to transport them out. It started working extremely well once it got started. I was providing support for everyone, providing ice and water and keeping track of the people going in and out so we didn’t lose track of any of our personnel. So even though I'm not medical, I feel like I contributed a lot, and I'm thankful that the guys

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who came up to me asking for water gave me the information about the nursing home. I feel honored that I played a part in that rescue.

**Gifford Saravia, Paramedic

Soon we discovered that they had a nursing home with approximately 70 patients still inside. There were many already dead, but the rest were still in relatively good condition, so the staff there started bringing patients to our triage area. Some of them were stable enough to be moved to the landing zone in a field across the street from the nursing home. That day I think we managed to take out 57 patients. It gave us a great sense of satisfaction, something concrete that we actually were able to accomplish that day.

**Levan Doucet, Paramedic

We were setting up an evacuation site at the intersection of Chef Menteur and I-10 in New Orleans East, where we were going to receive patients coming in by boat, triage them and send them on Blackhawks out to various locations. While we were setting up the staging area, a couple of men walked up to and said there was a nursing home three-quarters mile from our site that still had some residents in there. FEMA personnel and a couple of armed guards went to this site and con-firmed, yes, there were patients that needed to be evacuated, and they were pretty critical.

Initially we transported the patients by ground to the staging area, but then the Blackhawk pilot (I think they were National Guard) said that if we could move one of the vehicles in the parking lot he could land right there, which would eliminate having to stop at the staging area. So a bunch of guys on the scene physically lifted the car and pushed it out of the way. The Blackhawks landed right there, only about 50 feet from the nursing home.

There were a number of patients and it was very hot, and we helped the FEMA guys as much as we could; they were busting their butts. You know, considering every-thing going on, I was very impressed with the way everybody performed. I wish I knew the names of the two ladies that were taking care of these people because they did a great job. I met some heroes that day. They had been there for a week and had set up a mini-hospital inside the nursing home and a morgue as well.

I met a 99 year-old woman that we took out of there and I asked her, “Ma’am, have you ever flown before?” and she said, “No, sir, and I’m not afraid," so it was beauti-

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ful. That was her first helicopter ride ever...99 years old. She was just as with it as you and I are today.

But not all of them did as well as she did. They were in a whole range of conditions from very poor to very good. Most of them were in very good spirits, and I attribute that to the caring and positive attitudes of the nursing home staff. But a lot of them were exhausted and dehydrated, and some died before they could be loaded onto the helicopters. I heard that 14 people died before the rescuers showed up. I stayed till the end, I think around 5 or 5:30. We had people from Miami-Dade County Search and Rescue, we had people from College Station (Texas) Search and Rescue, we had another couple of guys from Illinois and I’m not certain who they were with, and everyone just worked together and it went very well.

**Dr. Ross Judice, Medical Director

During the New Orleans East operation on Friday, Gifford would lead our ambu-lance teams deployed with the US&R teams and I would stay in the US&R Com-mand Center in Kenner. When the onsite team found the nursing home, I got on the phone and talked with John in Acadian’s dispatch center and said that it was time to send the first helicopters to the landing zone. John tells me that Dr. Antoine Keller was calling to find out if we could help locate his wife’s grandmother. She was in a nursing home and the family was very worried. Unbelievably and to his great shock, I sent word to him that we were evacuating that very nursing home to the New Orleans airport, but also that there were some fatalities. Acadian flew him to the airport that day where he found his wife’s grandmother alive and well. Chill-ing.

**David Trahan, Telecommunications Analyst

Tuesday morning, right after the hurricane, we were to bring supplies to the Gretna station, evaluate the situation there and recover computers and other equipment. That was our primary mission.

We also went to the Superdome to deliver food and supplies, and of course we had to go through countless obstacles. We were going down Poydras and a National Guard guy stopped us and asked us to take nine elderly people with oxygen tanks to the Superdome. We told him we were in a supply truck that wasn't equipped to transport patients (we took the supply truck because it was tall enough to drive through the water). So he said he was going to "commandeer our asset." He had a white van with these people in it. He ordered us out of our truck, but a moment

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later a National Guard truck came by and the driver said he could transport those people. Their truck was so high it took a six-foot ladder to get into it, so we helped these nine elderly patients one at a time up the ladder. The first man I helped was about 80 years old and totally blind, but we slowly got him over to the ladder and had to physically help him up each rung.

**Dee Dee Sewell, Paramedic

There was an old man getting on an evacuation bus, and he started crying because he had wet himself and was ashamed to be on the bus with everybody. We told him not to worry about it because there were many other people there who were the same way, and he didn’t smell any worse than anybody else. He told me that for three days he had sat in his wheelchair and nobody took him to the bathroom. That poor man. The thing was there were no bathrooms close by and the people were so desperate to get on the busses that they didn’t dare leave their spot - even to go to the bathroom. They were hot and exhausted and they wanted to get off of this pavement place that had been their home for the past several days. The bus was their only way out of this misery.

**Remi Judice, Nurse Anesthetist

In the Superdome when we finally got helicopters going back and forth, Dr. An-toine Keller recognized that there were 25 nursing home patients in wheelchairs sitting there with no medical care. He wanted to evacuate them, but it was too late, because the helicopters had stopped flying for the night. So we had these 25 nurs-ing home patients just sitting there.

We decided to send them back to the DMAT area and at that same time there was a young lady with the military who said she might be able to get them out by bus. It was 11 o’clock at night, half of the patients were slumped over in their wheelchairs, and I told the caregivers to bring them back to the DMAT side, and if they wanted to evacuate by ground, they could do that from there.

**Kerry Hargrave, Basic EMT

Tuesday morning we arrived at I-10 and Causeway and found 800-900 evacuees standing in line. Some triage was going on. We immediately started picking people up, and I had a chance to speak to one of the ladies who rode in the front with me. She was 94, and told me that she'd woken up this morning and gone to the restroom, but when she put her feet on the floor, she was up to her ankles in water.

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She said, “Can you believe that? My husband and me came here in 1930 to look at this house, and we were told it was in one of the highest spots in New Orleans. So we bought it.”

She and her husband had never spent a night apart in 55 years of marriage. But now she didn't know where he’d been transported. I told her I'd get her name and social security number for FEMA and they'd help her find him. She went back to the story saying by the time her and her husband were able to get up into the attic, the water was almost over their heads. They had the clothes on their backs, and had grabbed their medicines, but dropped them on the way up to the attic. But water was coming into the attic at that point, so her husband cut a hole in the roof, and once they got out, the water was even with the top of the roof. So much for being in one of the highest spots in New Orleans.

**Liz Mrak, Paramedic

I was in the Superdome Tuesday and Wednesday. One of the things that kind of stood out was a daughter, aunt and mother that asked me for help. The aunt was in her 80’s and dehydrated. This was at the time when we were moving our first aid station from the inside to the outside of the Superdome. I put her on a cot, but then got distracted with other tasks because we were so busy moving patients and equipment out of the building.

A while later the daughter found me and said “Ma’am, how come ya’ll left my aunt inside?” I said, “What? Is she still in there?” I couldn't believe she was still there, and so was her 83 year-old sister. At this time things were getting rowdy inside the Dome; they were looting the vending machines next to our first aid station. So I grabbed an MP and said that I needed to go back inside and get two more patients out. He got four more MP’s and they surrounded me, along with some more Na-tional Guard people, to help me get these ladies out of there. The ladies eventually got sent over to DMAT where they got hydrated, and when we were sitting on the flight line ready to come home, I got to see them get on the helicopter, and that felt great.

**Dr. Ross Judice, Medical Director

There were Alzheimer’s patients wandering all over the Superdome. They had no idea where they were or who they were. They had no identification, and didn't have their medications. It was heartbreaking. All we could do was try to calm them

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down, talk to them, hold their hands and find ways to distract them until we could fly them out of there.

I went out into the stadium stands because of a request for help that came to the first aid station. While I was checking an elderly lady’s vital signs I asked the elderly man sitting next to her how he was doing. “I take chemo for lung cancer. Where am I going to get my next chemo?” I said, “Let’s get you out of here first and worry about chemo tomorrow.” Assuming the two were married, and trying to change the subject, I asked how long they’d been married. The lady said that they didn’t know each other and that her husband drowned in the flood. My heart sank.

When people in the stands would see you were a medical person, they would yell at you from the next stadium section over, “Come over here” to check out another sick person. One confused elderly man got his foot stuck under the stadium chair in the row in front of him. His feet were huge, and he wouldn’t follow our directions. Paramedic Dave Babin and I spent 20 minutes trying to get that mammoth foot un-stuck. The crowd was giving us advice all along the way. I kept thinking, “Is this a crazy situation or what?” We finally got that foot unstuck and we sat in the bleacher chair, looked at each other, and started laughing at the weirdness of it all.

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Rescuers in the StormKatrina changed her path and headed northward, making landfall in Louisiana on Monday morning. The high winds ripped trees from the ground and peeled roofs off buildings. Nobody expected the levees to break, and as the water rose, witnesses watched helplessly as entire neighborhoods were swept away.

Optimistic, heroic, dedicated...these words only begin to describe the character and the integrity of those who worked in the rescue effort during Katrina’s after-math. With many of their own homes washed away and their own loved ones lost, these amazing people persevered in their professional capacities and exceeded ex-pectations of humanity and humility. Roles were filled, needs were met, duty was done and hope was fostered.

Responders slept with one eye open when the environment became unsafe in the Superdome, but still they stayed and worked until the military insisted that they re-locate for security reasons. Later, some individuals criticized the medics for aban-doning their post, but these medics had stayed the course and worked 24/7 when nobody else was willing to risk it. Many of them wanted to stay even after the mili-tary insisted they leave for their own safety. Round-the-clock shifts took their toll on medics and responders. Workers compiled, gathered and distributed long lists of supplies. People made incredible efforts to de-liver resources to places that were in great need but almost impossible to access. The numbers of those in need were far greater than any single ambulance company could capacity to handle.

The best and the worst of human nature surfaced in the waters of Katrina. Supplies were scavenged. Private companies volunteered their resources. Boats were com-mandeered. And shots were fired...

**Janie Fuller, Paramedic

Saturday’s meeting at the EMS expo, as I’m sure you can imagine, had a very de-pressed tone, knowing that we were probably going to get a Cat 5 straight at us. Af-ter that day, all the days kind of blended together. At some point, after the water rose in Chalmette, we ended up with 12 feet of water in the building we were stay-ing in, which was the government complex. I was able to stand on the second floor atrium and look down to the first floor, into 12 feet of water, with snakes crawling around and garbage floating everywhere.

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Looking out of the windows of the building, all you could see was water. I remem-ber as the water first started to rise, watching the vehicles, first it didn’t look so bad, but then when it started covering the roofs, it was terrifying. As the water continued to rise, we watched it get to a point that we couldn’t see the AC units on the roofs of the buildings anymore. It was kind of like watching a Hollywood movie; the spe-cial effects were unbelievable.

Sometime during that evening, we got a call about a female that had a hysterec-tomy within the past week and her blood pressure was dropping. Being the only medic in St. Bernard at the time, I got one of the councilmen, Joey DeFatta, to commandeer an airboat for me. We went upstairs and talked to Larry and Junior, Larry being the guy in charge of the OEP3 and Junior being Junior Rodriguez, the parish president. I told them the situation and got the OK to go down and do what I could for her, knowing that we couldn’t get her out. There was just no way. Ground transportation at this point was zero.

**Billy Vincent, Paramedic

To see the Gretna Station after the hurricane was a sight to behold. The whole front side of the station was blown out. The back wall of the mechanic shop was gone. The big roll-up door was blown into the station. Parts of the inside of the station had gotten wet, because part of the roof was peeled back. It looked like a war zone. I stayed there through Tuesday evening and was relieved by Conley who came back to start cooking and feeding the crews.

**Jeff Thibodeaux, Paramedic

I was sent to Thibodaux Monday where we pretty much rode the storm out that night at Thibodaux Regional Hospital with the other three crews, and I tell you what, when you see 80–90 mph gusts, it is pretty horrendous. We knew it was get-ting pretty bad because they sealed off the ER with 4x8 sheets of plywood and we pretty much stayed inside. As you know, when the wind gets above a certain amount we have to stop running the ambulances. So we stood by and saw a couple of people come in from the storm. One was 37 weeks pregnant and I delivered her baby. The other one had a heart attack; the family had done CPR and drove her in from Chackbay.

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3 Office of Emergency Preparedness

**Danny Garretti, Paramedic

The hurricane hit late Sunday night, early Monday morning. They had moved us out of our station in Ocean Springs4 to the Ocean Springs Middle School, which is about three miles from the beach. That was scary, truly scary. They had a motor home in the parking lot and it was shoved about ten feet out of the parking space. Trees were being launched about four feet off the ground and looked like they were flying at 100 miles an hour.

At night nobody got enough rest. You might get two hours sleep in 24 hours. I mean it was kickin’. I went six days straight like this. Oh my gosh, I was loopy. On the sixth day I didn’t know how I was surviving. Shana Green was my partner. She made things pretty good. She was there the whole time with me except for the first 12 hours. We managed to entertain each other and laugh when things were bad. I tell you what, it truly hit home with the sights we saw.

I saw lots of body bags. We interfaced a lot with the Fairfax5 Search and Rescue guys and they were telling us what they were doing. It was truly humbling. The little body bags which represented a little body – that really gets to you. But that is one of those things. I guess if it’s your time, it’s your time.

**Jay Authement, Paramedic

In St. Bernard on Saturday and Sunday before the storm, we evacuated people from a couple of nursing homes. After that I went home, got the family together – wife, kids, and mother-in-law – packed them up and sent them to Memphis, TN. I planned to come back to work Sunday night. So I called my supervisor and he said, “Jay, operations are cancelled. Don’t come to work; take care of your family.”

The family was ready to go to Memphis, so I said, “Ya’ll go on, I’m going to stay with the house and try to save what I can,” figuring it wasn’t going to be that rough. My father’s house right next to me withstood Hurricane Betsy, so my father said he’s going to stay in his house too, no matter what. He’s about 70 years old, but he gets around good. So the two of us decided to stay in our houses, next door to each other.

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4 Ocean Springs, MS

5 Fairfax County, VA

We tied the boats up, and when the hurricane passed with the winds sometimes up to 150 miles an hour, we were outside in a little foyer where we could watch the trees blowing down, and we'd say “There goes that one, there goes this one.” Every now and then we’d see a tree go down and then a roof flying off.

When the rain was done, the wind done with, and the eye passed, the second part of the hurricane came, and the wind was stronger. But again, there was never any fear. It didn't seem all that bad. Even at 150 mile per hour winds, seeing things blow around, the house didn’t, never once, shake or anything; same for my father’s house. The rain was minimal. We had maybe a half-inch of rain on the ground. So I thought, well this isn’t bad at all. Roofing tiles were gone, but those are easy to re-place. The house was very secure with no water inside, so we were doing good.

My father sat at the kitchen table in my house and I went outside after the hurricane passed, and that's when I noticed water was coming in, like running over a bathtub. And I hollered at my father because I remember my grandmother once saying something about a storm surge, and I told my father that one of the levees must have broke, and we need to get out of here.

I was running to our big flatboat, which was on a trailer, and I jumped in the boat and cut all the ropes. I got my father into the boat; we were already in 3 feet of wa-ter. For some reason the boat, even though it was untied, created suction and wouldn’t come off the trailer. So I had to swim underneath it and released the suc-tion. So now the boat was floating and we were secure. This all occurred in maybe a 15 or 20-minute span. And as for our personal belongings, we took nothing. None. Everything was in those houses.

The last day, think it was Wednesday, I went through the house again, walking through the water and all, and I looked at everything and thought everything in here can be replaced, and wondered what can't be replaced. On the wall there were some pictures that managed to stay dry. Whatever pictures were dry, I took out the frames and put in a suitcase. In the attic I had some videotapes, maybe two or three, but the majority of the ones with the baby were gone. The ones in the attic that I could save I put in a suitcase. That’s the only thing I came out with - a suitcase of pictures.

**Julie Barousse, Paramedic

A nurse came and asked if I needed any help and I told her, “No, I'm just finishing. Everything is fine." She told me that her house was destroyed but she was staying at her mother’s down the road and they had power, water, electricity, hot water and

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food, so if we needed anything, to come down to her mother's place. I said, “Ma’am, the Baptist church is feeding us, but do you have any chocolate?” She said, “No, but I can make you some chocolate milk.”

I told her, “Don’t be shocked if I come knocking on your door later asking for some chocolate milk." Well, when I went to the Baptist Assembly Hall for dinner that night, this nurse had dropped off a bag for me… a huge Walmart shopping bag full of chocolate candy bars. I mean, there was probably 50 or 75 candy bars in that bag with my name on it and a little note that if I needed anything to contact her at this address and phone number. I almost cried. I almost cried, because here she is, lost everything, and she went out of her way, probably drove to Walmart without hardly any gas in her gas tank, to get me some chocolate. It was awesome. Makes me want to cry just talking about it.

**Paul Fuselier, Paramedic

Something that’s going to stick with me for as long as I live is the fact that we had employees who lost everything; I mean, literally, no homes. Their families were safe because they'd evacuated them. There were these guys who had been working three… four… some of them five days straight in horrible conditions. We’d ask them, “Hey, man, take a break, you want us to relieve you?” and they’d say, "Where am I going to go? I have no place to go. My family is safe. I am better off right here.” He was around friends and he was being productive, so I guess it was the better place to be. That was difficult because, you know, I had a place to go home to when my job was done there. I had a roof over my head and these guys didn’t. So to see them stick it out and still want to work and help was just amazing to me.

**Gifford Saravia, Paramedic

That day in the Superdome first aid station we continued to treat patients as they came in. We were doing stuff that was appropriate, yet under normal circumstances we would have had some orders and some guidance. Basically we were just im-provising the best we could on our own. This continued until about 2:30 a.m. and then David Lacombe and I climbed up into one of the ambulances -- in the front and passenger seats -- and we got some shut-eye. But I woke up about every hour or so looking around, because you never knew what to expect. There was a strong military presence at that time, but we still didn’t have total security.

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**Dee Dee Sewell, Paramedic

I flew out to I-10 and Causeway to evacuate and triage. When we got there, there were people as far as you could see in every direction, behind the barricade - just a sea of people as far as you could see, and they all needed to get on buses and get out. When I was coming back to Lafayette later that night, I threw up off and on all the way home. This little story is sort of funny I guess although it wasn’t at the time. I hadn’t eaten all day, even though there was food there; I had no time to eat or drink. Whenever I'd finally get a bottle of water, I would start to drink it and some-one would yell, “We need help over here,” and I'd put it down and go run to help. So before you knew it, I'd been there all day without eating or drinking and I had developed a “killer” headache. I had been working since the hurricane doing CISM6, and I didn’t have my blood pressure medicine with me. So I told the triage doc that I had a headache, and he said, “Oh, I’ll fix you up,” and gave me two pills and I said, “What is that?” and he said, “That’s two Tylenol.”

So, a little while later, I’m sitting there for a minute in a chair (we finally had a little bit of a break) and I was talking to one of our medics from New Iberia. I noticed I was beginning to feel really strange. My head was woozy and my arms felt like lead. I was lightheaded and everything was spinning, and I was frightened and alarmed because I’m thinking I’m having a stroke on theCauseway in the middle of a hurricane disaster. This is terrible!

Then I thought: “Wait a minute, I’m not having a stroke, and what did that doctor give me anyway?” I went over and looked at the bottle and it was Hydrocodone. and it was 7.5 milligrams and he had given me two of them. Well, I weigh about 105 pounds, and I took it on an empty stomach so that was not good but it ex-plained a lot. I almost passed out. They made me lie down for about 20 minutes, and then I got up. I was okay except that I threw up every 10 minutes. I would be running around taking care of patients and then I would run over to the trashcan and puke. I’m sure that wasn’t very reassuring to the patients, but looking back, it was kind of funny.

On the way home that night we brought back a doctor who had been trapped in one of the hospitals for days since the disaster began and she was just beside her-self about all she'd been through. I’m not going to say she was hysterical, but she was very stressed and shocked, and very emotional. They had no water, no electric-ity, and they hadn’t been able to communicate, which was the case at several of the hospitals. She told me that the first night they had patients dying because there was

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6 Critical incident stress management (CISM) is a peer support system used to help medics manage the extraordinary stress from witnessing life and death situations.

no dialysis, no medicine for them, and to watch her patients die was just so wrong. She said she’d go outside near the emergency department for a smoke break and hear people in the neighborhood crying out. There were old people and young people, and little children, and booming father’s voices saying, “Help me! Help me!” And little kids' voices crying for their mommies.

She imitated the big booming father’s voices, “My children are drowning! We’re drowning! We’re in the attic! We can’t get out! Somebody, please, I can’t hold on anymore. Please, somebody help me!” And the next night she said there were fewer voices and fewer lights – about half as many – and then the next night there were even fewer and her voice broke as she said this last part. She told me she has worked as an emergency room doctor for many years and she’s seen people die, but she’s never had to listen to people die like that. We rode together in the dark in the back of the ambulance for awhile and the silence was deafening as we thought about this and I think both our hearts were breaking for these poor, poor people.

We have been going from station to station assessing our medics who have lost eve-rything- their homes, their family members - everything. We’ve been going to see them for support and for CISM, and we’ll be going back to do more of that later. These medics and rescue crews are working so hard because it’s all they know to do right now. They are working in some very stressful situations where they are afraid for their lives, because they go into homes where they can’t transport the pa-tient, but they still need to respond and take care of them. And I've heard that peo-ple are shooting at the rescuers now. I’ve heard stories where the medics will start an IV and have to just instruct the family on how to stop it when it is finished be-cause the patient can’t go to the hospital. Only the absolutely most critical patients can go to the hospital, and this goes against everything we’ve ever been taught. Our philosophy at Acadian Ambulance is that if a person is sick, they need to go to the hospital and it’s our responsibility to help them understand how important it is to get medical treatment. We’ve never had to turn people away or tell them that we can't take them. This was an unbearable situation for us. The decision to not take a sick patient is unbearable.

**Tammy Gaudet, Paramedic

I am working out of Covington7 East right now and I would like to say thank you to all of the fire department, especially those in Folsom that allowed our crews to come over there. They made space for us, fed us, gave us water and we greatly ap-preciate everything they did do for us.

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7 Covington, LA

All the medics have worked major overtime, trying to keep the trucks running so we can evacuate patients and checking out homes for people in addition to caring for patients. We have a crew right now that’s going out trying to find someone’s family member because no one has heard from them since the storm. Not having any communication with dispatch or our family members the first few days was hard, but we’ve all managed to keep good spirits and stay positive through all of this.

Care Ambulance Service out of California, they came down and helped us a lot. They’ve given us trucks and split up their crews to work with us. And with the Fol-som Fire Department we all had food…we barbecued the minute the rain stopped. The guys got out there and started cutting trees down. They cleared Highway 25 and 40 by that night. We were very well taken care of and could not have asked for a better or safer shelter.

**Kimberly Lewis, Paramedic

Friday and Saturday night we went back out to Slidell. It was like a tornado hit it, it wasn’t a hurricane, and it was a tornado. All the streetlights had been picked up like toothpicks. So it was real bad out there. They had no power and everything was just ripped to pieces.

There were 150 firemen at one fire station all helping out there. They had been do-ing search and rescue for three days and hadn’t been home in six days. These guys were from everywhere...Texas, Arkansas, everywhere. They were going into houses and finding people, seeing if they were alive or not, and they were doing search and rescue through three feet of sludge. It was bad.

It ended up that me and several other girls helped out by cooking for these guys one day. I couldn’t cook fast enough. I mean, it’s not in our job description, but these guys needed to eat. So for four hours we were in a kitchen like 1950’s women, cooking for the men… me and two girls from dispatch and two other med-ics from New Orleans. One of those girls lost her house, and had nowhere to go back to, so she just wanted to work to keep her mind off it. These guys, my heart was with them. They were working harder than we were. I thought we were work-ing our butts off at the Causeway, but they were working really hard.

**Jason Hawkshead, Paramedic

From the minute I walked into the Superdome I started sweating and eventually we all stank. The place was so foul it was indescribable. I have smelled it one more

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time since then, the day after I came back from the Superdome, when my wife and I went to see how our house fared, and everywhere we passed where there had been a dead bodies sitting around for a week. It was the same smell, and I'll never forget it.

I learned a lot that night in the Superdome and saw the worst in a lot of people, and it bothered me a lot at first. But I’ve just come to understand that some people out there are like that. I saw the best in a lot of people as well. I know my skills have gotten better, my confidence level in what I can do has gotten better, and how I can recognize emergency situations from non-emergency situations has definitely in-creased just from the 15 hours that I spent in the Arena that night.

I remember looking over at one of the nurses and he didn't look well. He was an ER nurse from a big hospital in San Diego. I told him that he needed to sit down and let me start an IV on him. He realized I was right because he had not urinated all day and have not eaten in two days. It just took somebody to actually recognize the need.

**Jeff Hennessy, Paramedic

I came down from Chicago after getting a notice asking for volunteers to help with disaster relief. This is my ninth year in EMS. Originally, when we came down here we only had a one-way ticket. We got a letter from the governor giving us special permission for the flight to come in to the New Orleans airport, the first commercial plane to land here since the storm. So we got to land because we were a humani-tarian flight. But that was a one-way ticket, and our supervisors will make the ar-rangements to get us home.

There really is no way to describe it. It's beyond any comprehension. You can’t even imagine the things that I’ve seen. I flew over the city - just seeing the devasta-tion was incredible. The first thing that came to mind was this is a war zone. It was chaos at the airport. People were coming in any way they could. I saw airport bag-gage carts being used to carry three or four stretchers at a time, taking them out to planes to be evacuated. And all the people coming in after being out in the heat for days without medicine, food, water...it’s daunting.

Today is the first chance I’ve had to drive through the city, because until yesterday the farthest we had gone was the airport. Seeing how many people were coming through the airport gave me an idea of what must be going on in the rest of the city. I had to drive through the city and see it first hand…buildings torn to shreds, cars overturned, trees ripped out of the ground; I mean, massive huge trees, just ripped out of the ground, you can see the roots in the air.

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It's hard to imagine the force behind the hurricane that came through here. And to think that people actually stayed in their homes and lived through it is unbeliev-able. And there are still people in the city needing to be rescued. I can't believe some of the stories I've been hearing.

I’ve put in some long hours and I'm not even tired. I just want to keep working and keep coming back and doing more. I’ve put in two 24-hour days already. I mean you come back even though you’re tired because you know that these people need help. I started yesterday at 7 in the morning and I got off at 1 a.m. and I still got up at 6 this morning to do it all over again. You may be tired, you may not be sleeping under the most comfortable situation, and you may be sleeping on the floor in somebody's office. But at least I’ve got showers and I’ve got food. I’ve got clean clothing to put on every day. I’ve got a job.

I’ve never been involved in a situation like this before, but just from small-scale events in my experience, I know that it’s a lot of work and that people would be suffering a lot. So when they put out the call for volunteers, I jumped at the chance.

My company is working overtime. They’ve got extra hours to process, getting peo-ple up to the level of training that they need, bringing in people who normally work in the office and putting them on to the street… people who normally are inside handling paperwork are now out in the field doing the work. We sent down 50 people and brought down 20 ambulances, all loaded with supplies to be dropped off in the area. Can we afford to stay? I mean we still have our own obligations at home, to take care of our families and show up at our jobs. I check in every day, cell phone cov-erage isn’t everywhere, but I check in when I can at home and let them know what’s going on. You can’t tell ‘em everything because words can’t describe it. And that was the difference between being at home on Monday, Tuesday. Wednesday watching it on TV and then Thursday being here in the middle of it, it was so sur-real; actually seeing it happen.

**Neal Hargrave, Materials Manager

On Friday morning I received a call to meet with President David Pierce. At the time he requested, per Dr. Ross Judice, that we supply 100 ambulance stretchers as soon as possible. It seemed like a pretty major feat to get done considering these devices are not stocked in inventory, but built-to-order.

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I immediately got on the phone and contacted our representative, Kris Way in Kalamazoo Michigan with Stryker Medical Corporation. He said they would do everything possible to help us get that accomplished; he just didn’t know how many he could get done and how quickly they could get them to us.

Within about 30 minutes, I received a call back from him and he told me that be-tween what they could manufacture in one day and those orders that were ready to be shipped to other customers, he had come up with a total of 64 Stryker stretchers that could be airlifted out of Michigan and into the New Orleans area.

By 7 a.m. the next morning we had 64 stretchers being unloaded at the air charter services hangar. You know how we got those stretchers delivered? We received a call from World Jet who offered to fly in anything we needed at no cost so they flew in the stretchers from Kalamazoo Michigan at no charge. We loaded the stretchers, and by that afternoon they were on a 48-foot trailer headed to the group manning a hospital in the P-Mac.

Another story I’d like to share has to do with the New Orleans Fire Department (NOFD) and the Department of Health in New Orleans (NOHD). Dr. Judice re-ceived a call from someone with the NOFD explaining the situation that his or her employees were in. There were no supplies, no equipment. They had been wearing the same uniforms for five days and were in desperate need of some help and sup-plies.

Dr. Judice put together the list of what they needed and contacted me at 8:30 that night. One of the primary needs was to get some uniforms that the NOFD employ-ees could change into. We made some calls to different people and ended up with donation of 500 pairs of coveralls from ACE Uniforms in New Iberia, who had ar-ranged to get them from the manufacturer. Those uniforms, had we purchased them, would have cost $15,000. That manufacturer came to the aid of the NOFD and provided them free of charge.

We were also able get many other items that we are not accustomed to purchasing on a regular basis, such as chainsaws, jacks…things that were not part of our nor-mal operations. We put together several palettes of these types of supplies and sent them to the Lafayette airport and got them out to New Orleans as soon as possible. They were there in less than 24 hours. The word I got back was that the commander there was seen to have tears rolling down his face from the fact that Acadian ambu-lance cared enough to help them out.

I also would like to acknowledge some other donations:

• 3M Corporation donated electrodes

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• Easter Pennsylvania Ambulance Service brought full ambulance of supplies with them

• Microflex donated gloves• Southwest Medical Center donated a full 18-wheeler load of bottled water• Ferno, Washington—30 cots

I’d like to acknowledge the work of my Materials Management team. I’ve always felt like I had an outstanding team, and this event reaffirmed that belief. This group worked tirelessly for 15 or more hours per day. I never heard a complaint, never any issues at all, and so I feel really proud of the work our group did. We can cer-tainly feel like this group played a major role in saving lives, although we weren’t on the front lines, we did what was necessary to get the job done, to get the prod-ucts and materials out to the people in the field.

I’d like to acknowledge Gary Miller. As I mentioned before, my entire team played a great role in getting supplies out to the field, but Gary needs to be recognized for his work in New Orleans. He made an effort to bring supplies and equipment out to the Superdome on several occasions - sometimes putting his life in danger. He waded through water waist deep to get to the Superdome with supplies and equip-ment, at one point even feeling threatened by hoodlums, but luckily there was a military policeman on hand who was able to disrupt what was about to happen. We apparently had some looters trying to get their hands on whatever they could, and Gary was right in the middle of it.

**Remi Judice, Nurse Anesthetist

I called Robin Judice on Tuesday evening and asked how Ross was doing and if he needed any help. She said things were under control and I let her know that I would come help out if I were needed. During the night she must have spoken with Ross, because she called me around 5 in the morning and asked if I could round up some people to come down and help with the medical treatment and medical transport.

She put me in touch with Acadian VP John Zuschlag, and I asked John what he needed and how many people he needed, and then I started calling people that I thought might be interested in coming or might be available to come.

The first person I called was Antoine Keller. He’s a cardiothoracic surgeon with Cardiovascular Institute of the South and he said immediately that he would come. The next person I called was Scott Gammel, who works for LA Pain Management as an anesthesiologist and pain manager. He had to rearrange his schedule but made

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it work. I thought of other people to call, but I was unable to find anyone who was available. I wanted to fill up the helicopter.

I wanted to be as much help as I could, so I called my brother, Ronnie Judice, who lives next door, and asked him if he wanted to come and he said yes. We told him what to pack, maybe an overnight bag with some stuff and I packed my own stuff, plus the bag that I bring to work with stuff like atropine, epinephrine, syringes, my stethoscope, etc. I brought Ibuprofen from my home, Tylenol, baby Motrin, any-thing I thought kids might need, because I figured there’d be a lot of kids there.

I got all that ready and Ronnie and I met Antoine and Scott at Lafayette Regional Airport at 7:30. We waited for a supply truck that John Zuschlag was sending from Acadian full of supplies for us to take along with us. There were two helicopters available, but they couldn’t take all four of us with the supplies, so we divided up. Scott & Ronnie left on the first helicopter, probably 20 minutes before we did. An-toine and I spent that time looking through the supplies to figure out what was most important to bring, because everything couldn’t fit on the one helicopter with us. We took IV tubing, IV bags, IV gel…just first-responder kinds of things, and we left the rest to come on the next helicopter.

When we realized there were only small IV’s and the possibility that you could use central line catheters for some of the patients, we called several hospitals looking for donations. I called Southwest8, Antoine9 called Lourdes10 and we also called Dr. Mike Jennings who works for LA Pain Management to coordinate trying to get some more supplies sent down to New Orleans via Acadian’s helicopters.

I also called my wife, Lisa Judice, at University Medical Center11, and she scav-enged through the hospital for supplies, being it’s a public owned hospital. She went around and asked all the nursing managers what supplies they could let her have and she also got about $200 in financial donations from some of the nurses to buy supplies at CVS Pharmacy or Wal-Mart.

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8 Regional Medical Center of Acadiana in Lafayette, LA

9 Cardiovascular surgeon, Dr. Antoine Keller

10 Our Lady of Lourdes Regional Medical Center in Lafayette, LA

11 University Medical Center in Lafayette, LA

**David Maddox, Paramedic

I think this is a reality check for everybody to be thankful for what we’ve got. I’m thankful and have been blessed. My mom lost her house, but there is so much that we take for granted. I think that is the message for us all. In our daily grind of struggling with what’s not perfect, we should stop and recognize how fortunate we really are. We have shelter, a job, and a friend; there are so many that lost family, homes, jobs and everything they own. We need to be thankful for what we can find to be thankful for.

Stephanie tried to send me home three times, and each time I told her, “By all means, No." My family is fine, they are being taken care of and I was needed here. On the fifth day, some guy from Lafayette made me go home. They took my sup-plies, they took my unit and kicked me in the ass and told me, “Go home." It’s a blessing in disguise really; I got a lot done at home too. I got a generator set up. But I wanted to be out there helping people. That’s where I felt the most useful.

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Sick, DisabledIn our part of the country hurricanes are a way of life, and at Acadian Ambulance we have decades of experience evacuating people who are too sick to walk, drive, travel or survive without medical care. Evacuations are commonplace when big storms are headed to our shores. We are often called upon to move ill and disabled people from homes and hospitals.

Most hurricane evacuations are voluntary, but in Katrina a mandatory evacuation order was issued. The prospect of moving all those patients was daunting. We as-sumed -- as everybody else did -- that after the storm passed, things would return to normal and we could return people to their homes and hospital beds within a day or two.

We had no idea that the levees would break and the city would flood. We had no idea that 30,000 people would take shelter in the Superdome and that conditions there would deteriorate so rapidly. All we cared about was getting the sick and in-jured to safe place where they could be treated. But there were tens of thousands of them, and our resources were stretched to the limit.

Even our most experienced medics had never seen anything like it... nursing home residents drowning in their beds, dead bodies piled up in hospital corridors, thou-sands upon thousands of sick people -- diabetics, stroke victims, amputees, men-tally ill people, newborn babies, pregnant women -- all struggling to survive, many of them without their medications or supplies. For the sick and disabled population, Katrina was a nightmare beyond imagination.

**Paul Fuselier, Paramedic

You know, I’ve been doing this work for 24 years and have been through hurri-canes, tornadoes, all kinds of disasters, you name it. But this was one experience that I have never in my 24 years imagined. I had to do things that I thought I would never do. As medics, we have a slogan: Everyday we save lives. That is what we strive to do every day in our normal work. We have a patient or two or three on a typical day, and we do everything we can for them.

But we were placed in a situation in the Superdome where there were just too many people that needed help. We triaged people; we placed them in categories, and unfortunately, there were many in the category of ‘we cannot help you.’ They

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were simply not going to make it, and we knew it. When we triage, we tag patients with different colors according to their status. And it goes from anything that is real acute to minor, and there’s a category for imminent death.

The color code of that category is black. We "black tag" those patients. You can't imagine how difficult it is to place a breathing patient in that category. I had never done that before in 24 years. That’s just something that we don’t do in a normal op-eration.

There was somewhere between 20,000 - 30,000 people in the Superdome. They came to our first aid station and we’d triage them there, and if we could do some-thing for them, we would move them over to the Arena across the road where they had set up a makeshift DMAT hospital.

I don’t know how many hundreds and hundreds of people we saw. We were inun-dated. It was chaos. We had medics and doctors and nurses from all over the coun-try, a lot of them from the EMS conference that just happened to have been taking place in New Orleans the previous weekend. Some of those people stayed through the storm and beyond to help out.

The hardest part of triage is to black tag a person who's staring right at you, alive and aware. You get to a point where death is inevitable and you have to make a choice between that person and another person you can save. You only have so much time, so much manpower, and so much medication. Those are the faces that stare back at you.

**Dr. Ross Judice, Medical Director

We saw patients of all sorts. We had patients who were having heart attacks, strokes, seizures and an autistic teenager who had soiled himself. We transported elderly patients who were confused and didn’t know where they were. We saw psychiatric patients, Parkinson patients, patients who were roaming around the Su-perdome who didn’t know where they were, infants, a tremendous number of pa-tients who had lacerations on their feet and legs from walking through the floodwa-ters. I cleaned up a wound of a diabetic woman whose son tried to get her to a lo-cal hospital, carrying her on his back while walking through water up to his neck. At the hospital they were turned away, so they had to sleep in the flooded area until they were able to walk to the Dome.

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**Gifford Saravia, Paramedic

Within ten minutes of me arriving at the first aid station at the Superdome a man approached us and said that they had a diabetic who they couldn’t wake up, and he pointed us the direction of where he was. We grabbed a bag and took off. It took us about 10-15 minutes to finally find this man, and sure enough, his CBG was 29. We started an IV and gave him D50 and woke him up, and we told his neighbors to give him some crackers. Then we left. That’s basically how the treat-ment was there. I don’t even know the guy’s name. You just sort of did what you could and moved on because you couldn’t walk 50 feet without somebody asking you for assistance. There were people lying all over in the halls and aisles. Some were asleep, some kind of milling about, some just sitting there staring off into space. Some were probably dead.

**Billy Vincent, Paramedic

After the Superdome roof was peeled off by the hurricane, it was literally a thunder-storm raining inside the Dome. You couldn’t see from one side to the other for the amount of rain that was falling inside. It was a sight that was just crazy. After it was all over, the sun came out and the humidity level and temperature in-creased dramatically inside the Dome. Asthma patients started coming out of the woodwork. We were treating an enormous amount of asthma patients that had lost their meds because they were not able to get their inhalers when they were trying to escape from the hurricane. We became extremely low on medication. I think we were down to maybe one or two more treatments before we were going to be completely out of medication and not able to treat them.

I went to talk with the DHH12 guy and one of the doctors for the military, Dr. Foster Cordish. By this time some ambulance services from northern Louisiana including Shreveport Fire and Rescue showed up. We were able to get with those guys and pull a bunch of meds they were not using off of their ambulance. We also pulled every spare oxygen cylinder off of every Acadian ambulance. And we also pulled one main oxygen cylinder off of one of the ambulances to administer the medica-tion to these asthma patients. Those supplies lasted us for a short while – about a half or three-quarters of a day.

Sometime on Monday we were being inundated with diabetic patients that had lost their medications in the panic to evacuate, and their blood sugars were extremely

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12 Louisianaʼs Department of Health & Hospitals

high. Some of them were not even registering on our glucometer. We did not have any insulin and no medical order to give insulin. Dr. Cordish managed to find a box of insulin… about fifteen vials, and gave it to me with a sliding scale order to administer it. I can’t even imagine how many diabetics we treated in the time we were there from Monday through Wednesday with that sliding scale and insulin. His orders and the ability to have that supply of insulin truly saved many lives.

**Remi Judice, Nurse Anesthetist

One memorable patient was an alcohol abuser who had to be sedated. She was se-dated when she came to the staging area, and I thought maybe she was comatose for some other reason, but she was actually an alcoholic with withdrawals, so the DMAT docs sedated her with Versed and she was very sedated. She started waking up and got belligerent. I tried to give her every opportunity to leave the staging area; she could have been evacuated, but she wasn’t thinking clearly and she ended up leaving, sort of AMA13 from the staging area. She pulled out her IV and went back into the general population.

Later that evening they called for an evacuation for someone who was intubated and needed to be bagged. I didn’t see the patient; I just knew it was a priority. An intubated patient is critical in my opinion, so we transported that patient directly from the DMAT to the helicopter and bypassed the staging area.

The person who bagged the patient, Sergio, was a physician from LSU Medical Center in New Orleans. Sergio bagged that patient to Baton Rouge and it was dark by the time the helicopter returned…with the same patient onboard! The patient was going wild and they weren’t able to make it to Baton Rouge, so they brought the patient back to the Superdome. I didn’t know who it was; I thought it was somebody that maybe they'd found on the highway or somebody they had rescued from drowning. Come to find out it was this same alcoholic woman that had woken up from her sedation and ended up pulling the ET tube14 out in the staging area and ending up going round trip half way to Baton Rouge and came back be-cause she was so out of control and used all that fuel and manpower and was never evacuated.

I don’t even know what happened to that lady, but it really put things in perspective that you can’t control what these people were doing before the hurricane. She was

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13 Against Medical Advice (AMA) is when a patient refuses the medical providerʼs advice & proceeds on their own course.

14 Endotracheal (ET) tube is placed down the patientʼs wind pipe so that the nurse or medic can blow air into the lungs.

probably drunk on the street before it happened and just kept getting drunk and never had to worry about going into DT’s15 but when she comes into our world and we have to take care of her and have compassion for her, we have to treat her like she’s sick and do the best that we can for her, it's a different story. I decided to tri-age her out because I didn’t have the manpower, just myself, to take care of her and the other 10 people that were in the staging area, so I pulled her IV and told her to leave. We just had to make decisions like that.

There was one lady that was blind. I remember having to walk her to the helicopter. She couldn’t see, but she was very calm and it seemed out of place for her to be so calm, if you can imagine walking under a Blackhawk helicopter with the roaring of the blades above you and the wind and not being able to see. And she just walked as steady as she could, following my arm. We loaded her up on the helicopter and she took off. Never knew where she was going…to Houston, Baton Rouge, maybe.

There was just so much despair in the patients that came through the staging area, mostly the older people who were just resigned to the reality of the storm. They probably sat on their porches just two days before, waiting for the levee to break and having to be inconvenienced by this water and probably never expected to be brought to the Superdome.

**Richard Pellerin, Paramedic

There were times that we probably put six mothers with six brand new babies and one nurse in the back of an ambulance. We transported a mother with a one-day old baby that she named Katrina. We also had grossly obese patients on the ground for several hours until we were able to get them out of there, maybe 400 lb. pa-tients. I remember seeing cerebral palsy patients on ventilators, and they became a priority because the batteries were going dead on the vents. I know we had women that were in active labor that we were shipping out to the airport. We had patients from Lindy Boggs Hospital16 that were extended hospital stays; some were two or three days post open heart surgery, and they were out there in the elements fighting for their lives. I remember a gentleman that had been bed bound in the hospital for 6 weeks, and he was taken from that environment and thrown into the environment as an evacuee. I can’t imagine what that’s like, being in such poor physical condi-tion.

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15 Delerium tremens (DTʼs) are symptoms of alcohol or drug withdrawal - tremors, agitation, confusion, etc.

16 Lindy Boggs Hospital, a mid-city New Orleans hospital, was in the flooded area.

The AnimalsThe plight of pets in a disaster is heartbreaking beyond words. When the evacuation order was issued, thousands upon thousands of people tried to take their pets along, only to be told that they couldn’t carry them onto the buses, helicopters or military trucks. Many people simply let their pets go, hoping they’d survive on the streets, while others clung desperately to their animals, refusing to evacuate without them. Still others, having no idea how bad the storm would be, secured their pets in their homes and yards, thinking they were safe, only to discover that their beloved pets were now directly in harm’s way. By some reports, as many as 250,000 pets were stranded in the floodwaters in what became the largest animal rescue opera-tion in history.

**Jay Authement, Paramedic

When the water started rising, my three big dogs were in the utility room in the house and the little one was in the front of the house. My daddy’s house was right next door to mine, and his dog was inside. The water at this time was about 4 or 5 feet high inside the houses, and I was outside with my daddy getting into our boat. My daddy was crying, “I need my dog, I need my dog." So I said, “Well, alright, I’ll get the dog.”

I tried to open the back door, but it had suction from the water and I couldn’t open it. I busted a window and went in, swam through the house and got the dog, brought him out and threw him in the boat. The water was still rising, but it wasn’t that bad, so I decided to go into my house and get my dogs too. I swam in through the house and found the little dog floating on a mattress in my son’s room. The house, everything in there we can replace, but the dogs, that’s the one thing I have. So I went through the house one by one grabbing all the dogs and throwing them in the boat.

My daddy and me slept in the boat that night with five dogs. We found a place out of the rain on top of my neighbor’s car in his carport. We put the boat right on top of the car, that’s how high the water was. We slept there for the night with the ani-mals. I remember looking back into the house and seeing the cockatiel was up to his tail in water, so I had to hang him up high in the house so water wouldn’t get to him, and then when I got back outside, I noticed that one of the dogs was missing from the boat, so I had to go swim around looking for him.

By then it was getting rough with the animals in the boat. They were trying to jump in the water, I don’t know, nerves whatever, I kept having to jump in and get them

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and put them back in the boat, plus I kept going back in and out of house to get what food I could find. I’d go to my father’s house, swim through there to get little cans of Spaghettios, and then I'd go into my house, swimming around looking for food.

By the next night it was like, OK these dogs in the boat are going to kill us if they keep jumping out. The water was receding but very, very slowly and there was now only about a foot of water in the houses. So, I figured the big dogs wouldn’t drown if I put them back in the house; they could jump up on the beds to stay dry, so I re-leased them into the house, threw them whatever food was in the refrigerator, took off the storm boards so they could have some light and broke some windows so they could have some air. And I left them. I kept the little puppy and my daddy’s dog with us. The big dogs, I had to turn away from them, cause I knew I couldn’t save them.

We also had a horse. On the first day when the water stared rising, I put him in a shed that was elevated about two feet off the ground on cinderblocks. After the wa-ter got to be four or five feet, I thought the horse would probably drown, but it turned out he was high enough up that he survived. I swam out to the shed and found him caught up in a lot of mesh, so I cut him loose. His legs were in the water but the rest of him was above it.

We spent some time going around the neighborhood in our boat rescuing as many people as we could. We took people over to St. Bernard High School, which was an official evacuation site. But the police there said that people couldn’t bring their pets in, so people went up the stairwells to the roof and left their pets out on the roof in the hot sun, and the animals were dying left and right. From there, every-body got evacuated to the high school stadium, but some people wouldn’t leave their pets. One woman had a dog hidden in her duffle bag. The sheriffs came in and said, “If you don’t get out now, you’re on your own.” They put people in big trucks, and some of them got put on a barge going somewhere else, I don’t know where. But those people all left their pets out on that rooftop.

Eventually my daddy and I ended up at the stadium. Before going over there, I went back to the house and undid the door so if the big dogs wanted to run they could run. We kept the two small dogs with us, but from the stadium we were going to be evacuated by bus, and the police said no pets. So I had to leave the two little dogs there. There were people going through and systematically putting animals out of their misery. There was this policeman who went back to his house and got about 300 bullets so he could go back to the stadium and shoot the animals, including the puppy and my daddy’s dog. The ones back at the house, I don’t see how there’s any way possible they could have lived.

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**Dr. Ross Judice, Medical Director

During the Friday 8 am briefing at the airport, Theodore Monnette, the apparent head of FEMA operations at the airport, described the process by which the public and the medical patients would be evacuated. The meeting was attended by repre-sentatives from TSA (Transportations Safety Administration), the airport, U.S. Air Force, and others. There was a discussion about pets and Mr. Monnette said that all the animals would be transported with the people because we could not afford to upset the people by separating them from their pets.

But the military people wanted people with animals to be separated and moved to the commercial airlines so as to not have animals on the military aircraft. I spoke up for the first time at this meeting and said, “Having been in the Superdome for 36 hours trying to evacuate people on military aircraft and watching the pilots quibble about which patients they’d take and which patients they wouldn’t, I think that hav-ing pets on their aircraft is very small thing.” Mr. Monnette replied, “OK, well then that’s settled.” In other words he made the final decision to override the military’s stupid request to put people with pets only on commercial aircraft.

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SuperdomeKatrina hit on a Monday morning, but it wasn’t until Friday that the land evacuation of the non-medical patients started. By the time the military and FEMA showed up at the Superdome to start moving people out, there were about 20,000 refugees stranded in intense heat with no plumbing, electricity, food or water in dangerous, filthy conditions.

When the mandatory evacuation was ordered, all but the poorest, least self-sufficient people were able to get out of town. The upper and middle classes evacuated, but everybody else went to the Superdome, which was set up as a "shelter of last resort.” Once a mandatory evacuation is ordered, the city and state agencies are no longer obliged to care for!those!who stay behind. The agencies!are relieved of official responsibility and disclaimers are issued. !But the Superdome people stayed behind because they didn't have the resources to leave. Evacuation isn't cheap. You need to have someplace to go, a car to take you there, and money for gas. If you don't have friends or family to stay with, you have to stay in a motel. For someone who earns minimum wage,!$40 a night for a motel is way!out of reach.

Conditions inside the Superdome were deplorable beyond description. People were sick and dying everywhere, and during the first couple of days, the only help they had was a small first aid station manned by Acadian and a second medical area in the adjacent Arena, which had been set up by a FEMA Disaster Medical Assistance Team (DMAT) that flew in from New Mexico.

These medics worked tirelessly to treat and evacuate hundreds upon hundreds of sick and injured refugees, though evacuation was slow and inefficient with only a few civilian helicopters and Acadian’s small fleet covering the effort until the military arrived.

**Billy Vincent, Paramedic

On Sunday, a day before the storm, I was assigned to the Superdome to help get our first aid station up and running, because the Dome had been designated as a shelter. I left from the Gretna Station in the new supply van.

(Acadian manager and nurse) Ray Bias showed me around the Superdome, showed me where our first aid station was and where triage was going to be set up down-

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stairs. We had everything up and running early, before people were led into the Dome. I was assigned to triage.

About nightfall we started receiving trucks from different areas. Some of them were from nursing homes; some were from other places. I don’t have a clue as to how many patients we saw...there were thousands. The ones that stand out in my mind are the ones that we couldn’t help because we didn’t have the ability or the man-power to take care of them. This was the first time that I ever had to put black tags on people who might have had a chance to survive. I will remember those people’s faces for the rest of my life, knowing that in a normal situation, when there were places to send people to get help, those people would have lived. It’s just some-thing you train for, but not something that you ever think you really are going to do.

I did not mention previously about some of the great help we had. On Wednesday, four or five medics from Ohio and a physician’s assistant helped us at the first aid station. It was a blessing to have them there; they were stranded in town because of the EMS Expo, and they just came down and helped us out. It was unbelievable to have their hands and their help, because if they had not been there, we would have sunk, because we didn’t have the manpower to take care of all those people. The days all get blurred together because I didn’t get much sleep. Another memory that stands out was the day they needed some paramedics to fly on a Blackhawk with some patients who had to be intubated and sent over to I-10 and the Cause-way. So David Lacombe and I got on the Blackhawk to fly these patients out. There were two of them, and one weighed about 400 pounds. Both were intubated and bagged.

**Gifford Saravia, Paramedic

Tuesday morning at the Academy17 we were notified that our assistance would be needed. I had anticipated this and brought some clothes with me to work. Liz Mrak and I volunteered to travel out to the Dome. We got on a helicopter along with Ross Judice and we arrived there around 1:00 p.m. The first thing we noticed in there was the stench. Can you imagine 30,000 people piled up in a building with no ventilation, in high temperatures, with non-functioning restrooms? It was dark; about every tenth light was on, which was from an emergency generator, the only source of power in the building.

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17 The National EMS Academy (NEMSA) is the educational division of Acadian Ambulance. NEMSA edu-cates EMTʼs and paramedics.

You know what happens in a hot, humid part of the country like this when you turn off an air conditioning unit and the humidity comes up and the floors start to sweat? In the Superdome it was like that, but a thousand times worse, and the sweating floors turned into mud on the walkways. We had to be careful of how we walked because it was slippery and treacherous, not to mention that people were laying all over the place either sleeping, sitting up or just kind of staring off into space. We realized later that some of them were dead.

After a while you don’t smell the smell anymore, because once you’re in it and breathing it, you become immune to it. The first aid station was an 8 x 10 room with a stretcher in it, and equipment and supplies were piled up against the walls. They had police barricades all down the hallway, but it was too chaotic to contain. Essentially it was a free-for-all. The people were leaning against the barricades and the medics would try to give them supplies. The medics would ask, “What do you need? What is your condition?” People were walking up with anything ranging from a scratch on a finger to someone literally drowning in pulmonary edema. David Lacombe told me, “We need to have a clear point of entry, set up a triage area and a treatment area. We can’t have medics going back and forth to the fence because it undermines the order we need to create.”

It took us a while to get everybody to buy into it, but once everybody did, things started to go a lot smoother. We had an ER nurse there from the Houma area, so we set her up as the triage nurse – the first point-of-entry person. Everybody who was trying to lean over the fence was directed to her. Then we set up another treatment area for minor bandages and stuff. The second area we set up was for people who might need a nebulizer treatment or an IV or some further assessment, and we had four cots for that.

And finally, in the first aid station we eventually had a bed in there for the most critical patients. That’s the area I gravitated toward. It was kind of odd because there was no physician present. Dr. Judice was organizing the air evacuation at the time. We were all nurses and paramedics, but it was like in an emergency room, running critical patients and doing what we knew how to do. But we had no one there to give us orders or confirm anything. It was surreal.

We had some Gators for transporting equipment and people, and initially the med-ics would receive word of somebody needing assistance and would jump in a Ga-tor and go retrieve that person. But as the numbers of people in the Dome in-creased, this was no longer feasible.

Liz Mrak was manning the first aid station inside the Dome. Every now and then she’d call out over the radio that she had a critical patient who needed to be

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brought to the DMAT area, so we’d get a Gator routed over there to pick them up. At some point during the morning, the stench became unbearable, and that's when the security threats started surface. The National Guard thought it would be better to move the first aid station out of the Dome onto the plaza level terrace where the air was a bit cleaner and it didn't smell so bad. They completed that move and we started seeing patients out on the terrace.

I asked a lot of patients how they got there and where they were during the storm, and they’d tell me their stories. A lot of them waded through the water, some for several miles, to get to the Dome, and on the way they had seen bodies floating around. I haven’t yet heard what the estimated body count will be, but I’m assum-ing it would probably be safe to say around three thousand. It would not surprise me. A few hours later the military advised us that our position there was not defensible, so we were advised to move across the bridge which adjoined the Superdome to the Arena, and that’s what we started doing… tearing down everything and merging with DMAT team. At that point some of our relief started to show up. I got home about 11 p.m. on Wednesday...some 34 hours after arriving.

The next day they told us that our medics had evacuated the Superdome because it was no longer safe for us to operate there. We were then redirected out to Cause-way and I-10.

**Dr. Ross Judice, Medical Director

Our reach extended halfway around the Superdome, because when we would hear about somebody needing help on the far end of the Dome, we would always en-counter someone along the way who was in critical condition, so we’d stop and as-sess him or her. The Gator was extremely difficult to navigate around the Super-dome because there were so many people sleeping in the aisles, and we didn’t want to run over anybody’s legs. Obviously we didn’t want to hurt people, but we were also concerned that such an incident could elicit a riot.

Throughout the evening there were rumors being passed to us by the military that the generators were very close to going out. They told us that once it got dark in there, we would be in a very unsafe situation, so we developed a two-part contin-gency plan. Part A was to try to make it out to Gate C where some of our ambu-lances were. Part B was a stairway behind the first aid station that went all the way down to the loading dock where the military was receiving shipments of food, wa-ter, and supplies. Fortunately, the lights continued to be on the whole time.

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My assessment of the Superdome was that conditions were going to deteriorate very quickly. There were thousands of elderly people sitting in the stands, thousands of people coming to the first aid station with injuries and illnesses, thousands of people who did not have their medications (or their meds had been soaked in the flood waters), and the living conditions were sub-human. I knew we had to get all of the medical patients out of there as quickly as possible.

When I got to the first aid area the crews there looked weary. I asked if they were planning on working shifts and they just kind of shrugged. I called a meeting of the entire group and told them that we were going to work four-hour shifts still thinking that this would all be over soon. First shift was 10 – 2 and second shift from 2–6. We instructed them to put those times on the white board and that everybody had to sign up for one shift. I asked the folks who had signed up for the 10-2 shift to continue to work and the other staff needed to go get some rest.

At that point I began to work with this first shift, seeing patients throughout the first aid area and going out on calls with the Gator to assess and to transport patients. At one point I went out on foot alone, because someone had asked me to check on an elderly lady who had lost her husband in the floods, and also an elderly man behind her who had asbestos-related cancer. But once I set out on foot through the crowds, I was stopped over and over again by people pleading for help. I tried to see as many people as I could, if they required transport I would radio in to the guys manning the Gators. They’d drive around, bring the spine board and transport the patient to the first aid station. Those who appeared to be critical were trans-ported to the DMAT area.

Everybody in the Superdome was weary and traumatized. Some were very nice and appreciative, but there were also roaming groups of young men who in my opinion appeared threatening (though they never threatened us). I took a low-key, head down, eyes to the floor approach in the situations where it looked like people were fairly agitated so as not to inflame the situation any further. Some people were very helpful; they would come to the first aid station and ask us to go see about some-one, and we would dispatch one of our staff to go assess the situation and call for a transport if necessary. We were called to the security area down in the basement to assess a rather large gentleman who was having a seizure. He was probably 300+ pounds. We were finally able to get him transitioned over to the Gator and trans-ported up to the first aid station, then on the DMAT area. There were many obese people there, and it was quite a challenge to transport them.

The population of patients was growing all the time because the conditions were making people sick, and our ability to air evacuate them out had to be very aggres-sive to keep up with the deteriorating health conditions inside the Superdome. At

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this point I was aware that we were in a very, very serious crisis and that we were desperate to get these patients out.

The room we used within the Superdome was breached on one occasion when somebody from the public came in and began shining a light around, and we felt that our belongings were not secure. So we locked our personal belongings inside the ambulances.

On Wednesday I met with a Colonel named Pam (can’t remember last name) of the Louisiana National Guard medical unit that taking care of the special needs pa-tients. She told me that she wanted to try to evacuate the special needs patients (there were approximately 600 of them). She said that she had a plan and she wanted my help. I replied that I would do anything to help her out.

She wanted to basically load all the special needs patients into our ambulances and wheelchair vans that were parked at the Superdome and transport them halfway around the Superdome on the elevated walkway to the Poydras exit, where they would be offloaded onto army trucks and transported out of the area, presumably to waiting buses. There were security issues to consider because we would be transporting through areas accessible to the public, and people were starting to go a little bit crazy. This was an OK plan, but we didn’t have much fuel in our ambu-lances and our staff was tied up elsewhere so they couldn’t drive the ambulances. Pam said she could get some fuel, and that her army staff would drive the ambu-lances.

We turned over the keys to two or three ambulances and two or three wheelchair vans to her drivers. They had a loading crew get the patients onto the ambulances and vans, and a transport crew that drove patients around the Dome from point a to point b in a circular fashion. They would load them, drop them, come back, load them, drop them, and come back. It was actually quite an efficient system.

Not long after that, I received a call from our dispatch center requesting that I be evacuated by air. I assumed that they meant just me alone, and I refused to go. They then clarified that they wanted to evacuate the entire Acadian team that arrived on Tuesday, which at that time was only six of us; the recently arrived teams weren’t evacuated until the following day. Some of us had been there for 30-something hours, and once I heard this, I agreed, because all of us were completely ex-hausted.

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**Paul Fuselier, Paramedic

We had newborns to 92 year-olds coming in. It was from one extreme to the other. I’ve been to the Superdome before, to football games and different things, and I re-member the sights, the sounds, even the smells, like the smell of popcorn. But now my memory of the Superdome is totally different. It’s just gloom and despair.

I am proud of our people, Dr. Ross Judice and the other doctors who came in, those guys from Cincinnati, the Acadian people who were there. Some of them came in before the storm and rode the storm out in the Dome. Everybody worked hard and you didn’t hear anybody ask for relief or anything. We had to force some people to go home. We had people who were confined and trapped because of the flood, and there was so much difficulty getting them out; the National Guard trucks had to get them out through the water or fly them out. We were trying to get them out by helicop-ters as quickly as possible, but there were just not enough hands. We had a small first aid room with one stretcher and a few chairs for people to sit on. This first aid room was designed for one or two people at a time, not a hundred. And we had some other stretchers that the National Guard provided, so we could lay people down on them outside of our room. Sometimes if we were lucky we had ten re-sponders in there – medics and nurses and whatever. And other times we only had five people, and the line of people waiting for help seemed endless. It really taxed our people who had already been pushed to the limit.

**Kimberly Lewis, Paramedic

On Thursday I was assisting with transporting the patients from the Superdome to the Causeway, and from there they’d get in the ambulances and go to the P-Mac on the LSU campus in Baton Rouge. All the helicopters were going back and forth be-tween the Causeway and the Superdome. We’d load ‘em and go, load ‘em and go. All day Tuesday we received patients at the Superdome and then we'd send them out to Causeway. On Tuesday I think I was there for 20 hours.

**Steven Hamilton, Paramedic

I flew by helicopter into the Superdome with ten other medics.

Toby Bergeron, who told me that I didn’t know what I had gotten myself into, met me. Apparently there had been two murders about an hour before we arrived there.

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Toby showed us around, told us what we were to do, where we should go and where we shouldn’t go, all due to our safety. After getting a debriefing from him, I was assigned to work landing helicopters. We put patients on the helicopters to transport them out to hospitals or staging areas around the city or state. I quickly realized that this was a tough task because not all the helicopters that landed actu-ally wanted to take patients because some were delivering supplies and personnel only.

About midnight on Wednesday, the military shut down the flight operations. No helicopters were coming back until the next morning. I visited with one of the commanders to find out what time we were going to start the next morning and could never get a straight answer from him. He was telling me between 7:30 – 8:00, maybe even later. So I realized that these guys really didn’t have the game go-ing on at that time. I got pretty upset. Once that shut down I went to the treatment area and started helping the DMAT team. These guys were so helpful, so friendly, and it was good to be around them.

**Remi Judice, Nurse Anesthetist

When we got to the Superdome on Wednesday there were eight or nine helicopters that we could see, maybe three or four on the helipad and maybe five flying around as we flew in. Ross introduced us to some of the medics who’d been there for a while, and they looked quite tired. Dr. Scott Gammel took over the first aid station and I took Dr. Antoine Keller and we went down to the heliport where Ross was di-recting traffic. We asked him what he needed, and he suggested that we set up a staging area near the helipad. This was between the Arena where the DMAT people were housing the sickest patients, and the helipad. We tried to hold 10-20 some-times 30 or 40 patients at a time, depending on how acute they were, so there wouldn’t be much distance to cover to get them onto a helicopter to evacuate.

We were adjacent to the National Guard’s satellite communication, so we had clear paths back and forth to all the medical facilities, with security provided by the Guard. There was no big military presence at that time, only National Guard.

We tried to keep, in our triage station/staging area, maybe 5 stretcher patients if we could, and 20 walking wounded, so we would always have an immediate supply of patients for the helicopters when they came. When the helicopters touched down, we would hand communicate with the person at the helipad to figure out how many patients he wanted, because we didn’t want to bring patients more patients up to the helicopter than they could take, and then have to bring them back to the staging area again. That would be a big waste of manpower.

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We also had Gator vehicles to transport people from the Arena to our staging area, but we only had them for short times because they were usually busy elsewhere, so when the helicopters did land, we needed the Gators to transport the stretcher pa-tients.

The helicopters would drop off supplies on one side of the Superdome but would only pick up evacuees on the other side, so we never knew until the helicopter landed on our side how many and what kind of patients they were available to take, whether they were stretcher patients or walking patients. So my brother Roch and some Air Force communications officers were trying to make it possible for us to communicate with the helicopter pilots coming in.

Around 4 o’clock I started carrying two walkie-talkies, one for Acadian and one for DMAT, and so it was quite interesting trying to differentiate who was asking for what on which walkie-talkie. I felt like somebody on the floor of the New York Stock Exchange. I was actually bargaining with the people on both walkie-talkies, making deals about how many people would go here or there, negotiating. So for the rest of the day that’s what I did. I communicated between the DMAT side and the helipad, and at times there were no helicopters coming in, so we would just take care of patients, keep them out of the sun, keeping track of their IV’s, tak-ing them to the bathrooms...well, there were no bathrooms, so we’d take them out-side to a place where they could relieve themselves (there were no toilets for civil-ians to use). We decided to make all the males urinate in the used water containers so we could keep it as sanitary as possible, although the little that we did didn’t make much of a difference. Sanitation was impossible. The women were upset be-cause I could bring the men to urinate, but I really couldn’t bring the women until I found a female to escort them.

**Gary Miller, Distribution Supervisor

There was this older man wading in the waist-deep water coming out of the Super-dome. He walked past me and said that he couldn’t take it in there anymore and he didn’t know where he was going, but he just had to get out of there. You know, he was just shaking his head and waded off in the water. Who knows what ever hap-pened to him.

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**Dr. Chris Najberg, Emergency Medicine Resident

I personally saw some of the worst damage I ever witnessed. It was absolutely in-credible. You never knew what you were going to see next.

I arrived at the Superdome to find the crowd in an extremely agitated state, and the level of fear was increasing all the time. The National Guard was there, and most of them were carrying weapons. They were saying that evacuation of medical per-sonnel was beginning because they expected the worse to happen at any given second.

The crowd was restless, milling around in the stifling heat and stench, occasionally throwing an object, shouting or getting into shoving matches. Judging by the condi-tions in there, I don’t blame them for being angry. They had been living for four days in some of the worst living conditions I have ever seen. Sometimes the feces on the ground was six inches deep, and people were sitting in the bleachers with dead family members propped up in the seats next to them. I personally saw this, and my heart goes out to those people.

At one point I was helping to transport a female patient around the Dome in one of those big army trucks that was high enough off the ground to get through the water. She weighed 700 pounds, and we weren’t able to fly her out because of weight limits on civilian helicopters. The military helicopters could have taken her, but they were unavailable at the time, so we drove back into the Dome with her. For the moment, all we could do was leave her in the truck while we tried to figure out the best way to get her to a hospital in Baton Rouge.

I made my way back to the first aid station and told Dr. Bryant that the Acadian op-eration was pulling out due to great danger. I saw him off on one of the helicopters, and then went back to the truck and got into it with my patient, who had now been waiting in the back of the truck for nearly 12 hours in the extreme heat. We began to make our way through the city, passing groups of 500 or 1000 refugees at a time on the streets.

At one point we passed a group that had several members waving frantically to me, and by all appearances from 20 feet away I could see that there was a man with this group who appeared not to be breathing and possibly dead. I could not stop to help them due to my patient in the back, who was now breathing 50 times a min-ute, and my only medical supplies were an oxygen tank, a mask and a pair of gloves. There was nothing I could do for the man, so we just drove on, but we were pursued by 30–50 people screaming and throwing bottles and rocks, because they believed we were abandoning a sick patient.

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We made our way out of the city, passed barricades manned by police and citizens with weapons, I assume they were trying to contain the disorder. I saw several fires, and it was a very chaotic scene. I had never imagined anything like this. It was something out of an apocalyptic movie.

It took about four hours to get to Baton Rouge, and along the way my patient began to have altered mental status and developed mucus plugs in her trachea. I was able to get an Acadian Ambulance to intercept me at I-10 and the Sorrento exit, and they were tremendous help in giving me a portable suction unit to relieve the mu-cus clot, some oxygen and a BVM18, as my tank was nearly empty. I was able to bag her until she regained consciousness.

We stopped at Mercy Hospital and obtained a few more supplies at the door, as the patient was too heavy to be unloaded. At that time I chose to continue my transport with the patient to Baton Rouge, since she was now stabilized. We made it to Earl K. Long hospital without further incident.

It was now about 4:00 p.m. and I had not slept since 6:00 a.m. the previous day. I went home, took a long shower and slept for 14 hours.

The next day I was able to get back into New Orleans with the help of David Pierce, president of Acadian Ambulance, and I met with Ross Judice to discuss fu-ture plans. I spoke with several New Orleans Fire Department. personnel and they described what they had been doing. In my opinion, their actions were heroic. They had not had relief in a week and they were continuing to do search and res-cue, even though many of them had minor injuries.

I just want to add that I can’t emphasize how grateful I am to Acadian for providing me with this opportunity, and I have to say that they have gone above and beyond the call of duty. I did not know that they had this many ambulances, but I think I probably saw all of them in New Orleans, over 100 at least. I am thoroughly im-pressed and very grateful.

**Todd LaPorte, Paramedic

Everything was going well until about 2 a.m. on Thursday when our security -- which was actually military MP's that were guarding the ramp between the Super-dome and the Arena -- told us to move the first aid station our of the Dome and to inside the Arena. The guards were securing the area so that people couldn’t just ar-

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18 Bag valve mask (BVM) is a bellows-type bag used to push air into the patientʼs lungs.

bitrarily come in looking for medical help, there were also people coming to us seeking a way out, because they could see Blackhawks flying in and out evacuating people.

All of a sudden we started seeing MP’s running toward the main part of Dome. We found out later that one of the military guys inside the Dome had been shot, and that pretty much did away with our security. People started leaving the Dome — just walking out on their own towards the Arena, or wherever — who knows where they were going. We had gotten a report that there was a sniper out on one of the bridges next to the Arena that had shot a couple of people on the ground, so that was the biggest concern, because we had no security left.

Once daylight broke, we got the word out that we needed to get out of there and some helicopters were sent to pick us up. But by that time the area reserved for military and medical personnel had become inundated with people from the Dome, and there was a huge throng between the helicopters and us. We had to push through a few thousand people to get to our helicopters. It was obvious to the people that we were leaving, and they wanted to get on the helicopters with us, which was, of course, impossible. Once we got out of there and got back to the Causeway and I-10, things got much better.

Medical supplies were a big issue. Everything was pretty much depleted as far as medicine; there were no more diapers for babies, no medicines, nothing. Every-thing was running out. Dr. Chuck Burnell, an ER doctor in Lafayette, was working up there with the DMAT team, and he knew that I was the guy handling communi-cations, such as they were. He had a contact at VA Hospital that could get the medication we needed, so he asked us to find some boats or big trucks that could go through the water over to the VA to pick up the meds. We were able to get a couple of boats from Wildlife & Fisheries, and we also commandeered a National Guard dump truck that was high enough off the ground to go through the water. We were able to go to the VA and stock up with all the medications they needed…for the rest of the night at least.

We saw every kind of case out there. I know that several babies were delivered in the Arena that night. There were a lot of dialysis patients who were, of course, a high priority, because without dialysis — they’re going to go into shock. Those were the most critical needs that I saw, but otherwise it was just people who were really worn out and their medical conditions were worsening because of the heat, the stress, the exhaustion, and the filth. The whole situation was a nightmare.

To be blunt about it, the Superdome was basically one big toilet. I’m assuming people kept using the bathrooms even though the toilets were long since overflow-ing and there was no water. When you walked in the hallways it was obvious peo-

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ple were doing whatever they had to do wherever they could do it. It was the most disgusting thing you could imagine, and it was unbearable to be inside that build-ing. If we could have gotten stuff done sooner, if we could have gotten people out quicker, a lot of the trauma could have been avoided.

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CrimeAll of America -- in fact, all of the world -- saw the TV news images of young men stumbling around drunk, people “looting” and other negative depictions of the people in New Orleans and the Superdome. America passed judgment, or in some cases, just pretended that these folks didn't exist, except when one of them shot a gun or stole some tennis shoes, and then it was all over the evening news.

But the “bad guys” probably represented less than five percent of the entire group at the Superdome. The rest of the people were average, law-abiding, working class citizens. They're the people who worked as maids and janitors, drove the trash trucks and washed the dishes in the kitchens of New Orleans' finest restaurants. Yes, a few of them were drug addicts and alcoholics who were detoxifying in that hellish environment, and some might have been criminals or gang members, but they still deserved to be rescued. The whole group simply represented a typical cross section of poor urban life. If anybody was committing acts of violence it was the people who would be doing that anyway in their normal lives, so why would they be ex-pected to behave differently in a disaster?

From Monday until Friday these people!were stuck in the Superdome, struggling and raging and dying, and nobody!was in charge. The police!weren’t there, the Red Cross!wasn't there, but the National Guard was present and so were medics. Out in the floodwaters, firefighters braved the flood to rescue people despite losing their homes, braved the floodwaters to rescue people. The human effort was tremen-dous, but the local government was crippled by the storm, and there was very little order. The people of New Orleans had to!govern themselves, which was not some-thing they had the skills to do.

In the Superdome, the “fog of war” made it hard to decipher fact from fiction. Word of murders and rapes came from various sources, including the National Guard and other “officials.” Reports of snipers in the downtown area hung in the air for days. What was definitely true was this: the fear was palpable and real to the medical personnel and rescuers.

**Marc Creswell, Flight Paramedic

We got back to Touro hospital and the staff was preparing to commandeer some buses. I went with two New Orleans cops to get these buses, which were parked near the Walmart. Apparently a bunch of looters had gotten into Walmart, and po-lice were swarmed all over the place. The buses were waiting for us, and it was scary, because apparently there had just been a firefight between the police and the

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Walmart looters. There were about 100 New Orleans cops surrounding several square blocks, and they had blocked off everything.

We managed to get the buses and I rode in the first bus with one of the New Or-leans policeman, who was armed with a shotgun. He gave the bus driver the order that if anyone got in front of us or tried to stop us -- which could be an ambush or something like that -- he should do what he had to do to evade the person. But if evasion wasn’t possible, just run them over. The driver understood that and we took off driving really fast.

The cops had been fighting hoodlums all over the city now for at least 36 hours, and they hadn't eaten and were hungry and thirsty. At one point we spotted a guy coming out of a convenience store with a shopping basket full of food and Gator-ade, allegedly a looter, and the cops took him down at gunpoint and took his food.

We finally get back to Touro, and got those folks out, and eventually we were there by ourselves. Security detail had left, and it was just me and two other guys. At one point we noticed that two guys were trying to crawl up the side of the parking tower trying to get into the hospital, probably looking for drugs, so we started throwing tuna fish cans and empty water bottles at them, trying to get them off the tower. Then we got our helicopters and got out of there, because it was just too hostile.

**David Trahan, Telecommunications Analyst

Leaving the Superdome one day, I had to drive through a crowd of about 15 people standing in water. One little girl started to move out of the way, but her mother grabbed the child and actually put her in the path of my truck. I guess she wanted us to stop and help, or give her a ride, but it just wasn't possible. We couldn’t drive around the child because the road wasn’t wide enough. So I slowly drove to the left as much as I could, and the child finally did move out of the way. It was a strange attitude that was prevalent every once in a while, but people were desperate.

After getting back to the Gretna office, we heard that there was gunfire on our lot and some looting going on in the neighborhood. They had stolen our generator right from under us and one of the deputies ran out and fired his machine gun and dispersed the crowd. At this point we were ready to come back home to Lafayette, and a law officer came over and asked us if we had guns because he was con-cerned about our safety. He wasn’t there to help escort us; he was just telling us that we needed protection. We didn’t have any guns or anything like that, and we had to go through an area where people were starting to gather before we could get up to Highway 90.

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Before we left we were under strict orders that under no circumstances were we to give up the truck. We were told to run over anybody that may want to stop us, and if there was a crowd, to plow through the crowd. Whatever happens, do not give up the vehicle. It was martial law.

Well, I told them I wasn't sure we could do that, and luckily we didn’t have to. We had one situation where we had to stop, but the crowd did not try to take our vehi-cle. During this whole period we did witness a lot of looting. We saw people steal-ing post office trucks and things like that.

We made it back to Lafayette and spent the next day reorganizing the communica-tion center. The next morning, I’m thinking this was Friday, it was decided to move out of Gretna because things were not safe there. We left in the middle of the night with a couple of armed guards with machine guns, and when we got to the Gretna station, it was total darkness, and these guys were running around with flashlights on the ends of their machine guns clearing out the building and the parking lot. At one point a car came around very slowly, and the guys with machine guns were screaming and yelling, and we hid while they ran around in the dark securing the area and waiting for something to happen. But the guys in the car just scanned their headlights around the parking lot and left. So nothing happened there, but it was a tense moment.

**Randall Trahan, Paramedic

The first days I spent doing evacuations from nursing homes. The second day, Wednesday, I ended up getting yanked by Coast Guard helicopter to the Lakefront Arena on the campus of the University of New Orleans. I was basically the only medic out there, but there was also a doctor, a pharmacist and a nurse with up-wards of 1,200 people needing medical attention. From 9 am until about 4 p.m. about 5,000 evacuees found their way to us.

There were numerous babies, kids, old people and sick people, and there was no food and no water until some of them ended up stealing from a Safeway and bring-ing food down there to the shelter. Instead of giving it out, a lot of these individuals were selling it to the other refugees.

This place became a shelter due to the fact that it was the closest spot on high ground, and FEMA, the Red Cross and other authorities didn't know people were congregating in this location. People were coming out of the water from the boats, and there were truckloads of people just driving on in. But no one knew we were there. There were no supplies and no food dropped there. There was no military

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presence and no police presence, and violence was erupting at night. The doctors and nurses were getting scared. I made my way out of there after about seven hours and notified someone that there was a big problem over there.

**Voice mail received September 1st @ 9:34 AM

“Keith, I have an emergency at Tulane Hospital. They’re shooting! Their medical personnel are inside the building. I need to get a helicopter to the roof of Tulane Hospital. Michael _______ and medical people are being shot at and I need to get a helicopter to get them out of there. My name is Carol _____. I am calling from New Jersey. My son, Michael ________ has called with an emergency call for the medi-cal personnel. Please call me back immediately…”

**Billy Vincent, Paramedic

On Wednesday, it was me and a paramedic named Stephanie on the flight line try-ing to catch a flight. The majority of the group had already been flown out. Dr. Ju-dice had gone downstairs to check on the first aid station and get a bite to eat when a person with a gun started shooting down at the Superdome from the parking ga-rage across the way. We took cover underneath the second story of the parking ga-rage where the military had set up their bunks. The military flew a Blackhawk heli-copter over to the parking garage and dropped off some military personnel. Later they came back and let us know that there was nothing to worry about; they had taken care of the problem. They didn’t get specific on what “taking care of the problem” meant.

**Steven Hamilton, Paramedic

One patient at the Superdome was a soldier who was shot in the right thigh. It ap-peared to maybe be an accidental discharge of his weapon. One of the doctors in the Arena who took care of the patient was a surgeon. He told me if it was probably another half inch to the right or left this patient would not have lived; he would have bled out right there and there would have been nothing we could have done.

About 7:00 the next morning, Thursday, Todd LaPorte contacted dispatch and ad-vised them that it wasn’t very safe at the Superdome. We had some hostile people coming over to the Arena from the Superdome. We got multiple reports that they were trying to set fires, and these reports came from several people and military. Dispatched advised that it would be unsafe for us to be there, and within an hour

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all 11 of us were evacuated out of the Superdome and back to the Causeway & I-10.

**Jason Hawkshead, Paramedic

We left on a helicopter from Lafayette going into New Orleans and arrived at ap-proximately 9 p.m. Coming into the city, the only thing that was visible was police cars with lights everywhere like little ants going in between all the streets. When approaching the Superdome we went in a circling pattern because they wouldn’t clear us for landing because it was not safe. We were advised in advance that it was unsanitary and not exactly the safest place in the world, but we all volunteered to go into there anyway. They finally allowed us to land and told us that there had already been multiple murders in the Superdome that night and that the citizens were restless and hostile towards our presence. I did not see any police there at all. I saw mainly just Na-tional Guard, FEMA, and us. We were to operate above our license level, and we were told that if we felt comfortable doing it, these people needed us, and to go ahead and do it. The situation was dire when we arrived. I remember there were at least 30 people in need of medical attention and at least half were in serious need, such as hypo-glycemia, severe chest pains, severe shortness of breath and four women about to give birth. For the first time in 9 years working as an EMT-basic, I saw three births that night. Whatever illness or problems people were presenting with, pretty much everybody got a nerve pill or a shot of Valium just to help them calm down because it was very, very frantic in there. At some point during the night there was an MP who got shot through the leg with his own MP5, so a doctor, a paramedic and I worked on him. I believe that’s when the severe hostilities in the Arena and in the Superdome really kicked off, because he was one of our own and he had been shot, and that put everybody in a panic. He was put in a helicopter on his way to further treatment, and that made people mad because there were people dying and they didn’t understand why he got to go out first. So that incensed the crowd dramatically. Also that night we were told that we could no longer go outside of the Dome be-cause there was a sniper shooting at us. Apparently the sniper was trying to hit any-thing in a uniform. He shot four people under the mezzanine in between the Su-perdome and the Arena, but this may have been just a rumor.

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The supervisors on the ground made a decision at daybreak to get us out of there because it had become totally unsafe. It was no sooner than 4 or 5 minutes after they made that call that our people were leaving on the helicopters. I’m thankful for the opportunity to go and experience that, yet it scared the crap out of all of us.

**Kimberly Lewis, Paramedic

We were on the I-10 and Causeway on Thursday. The crowd started getting real restless and it was a bad situation and I was on a helicopter back to the Superdome to get our guys out of there because it was getting bad there too. On the way, when we were off-loading and getting back up in the air, there was some people about 2 miles out from the Superdome -- I don’t know if they had been looting or what -- but they had guns and I think they were trying to get our attention, not to get res-cued, but just to get our attention, and they started shooting at the helicopter.

We had critical patients on there with us. One of them needed surgery, a vent pa-tient that was critical, and the whole helicopter was full. So when that started hap-pening, we all started freaking out. We had the National Guard with us and they said, “They’re just trying to get our attention; they don’t know better.” But just the fact that they were shooting in the vicinity was very scary.

**Gary Miller, Distribution Supervisor

We headed back to Gretna after dropping off food at the 1-10 & Causeway triage area and helping there for a while. Once we got back we were told that a genera-tor was stolen. They were also trying to steal three trucks a block away from our post. One of the deputies stationed by us shot in the air to scare them off, but that didn’t work, so they shot with an M1619 and that stopped them from getting the third truck, but they did get away with the first two.

Near the Superdome we actually saw people taking U.S. Mail trucks – there were 15 or more people in the back, one driving, and one on the side, just going down the road like it was nothing. After passing them, we noticed a cop had another mail truck pulled over with the same number of people inside it. When the cop no-ticed these other stolen trucks coming down the road, he got in the middle of the road and pointed his shotgun at them and made them pull over. It was stuff you'd never think you'd see. It was like a movie. It will stick with me for a long time – the sights, the sounds.

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19 The M16 is an automatic rifle used by the U.S. Military and law enforcement.

A cop walked up to me and asked if I had a weapon. I told him, “No,” and I asked him why. He said, “Because y’all need to be protected. These people are at the point where they will do anything to get what they want.”

And I noticed it was getting a little crazy as we made our food runs. In fact, during the last food run I asked for a police escort because I felt that we were in danger if we went out there again without protection. After one run, we opened up the truck and immediately two big guys came around the corner, but when they noticed the cop behind us, they backed up and just said that they thought we might need help unloading the truck. I know that was not their intention at all, and without that es-cort, things would have turned out a lot different. We saw looting everywhere. I mean, it was, you know, you just couldn’t believe it to see it. They weren’t in a rush to get away; they would just casually walk away like it was nothing. It was a pretty wild experience that I hope I never see again.

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St. BernardSt. Bernard Parish was one of the hardest hit areas of New Orleans, and even now, five years later, residents are still trying to make sense of what happened there. Ac-cording to a description on Wikipedia, “The storm damaged virtually every struc-ture in the parish. The eye of Katrina passed over the eastern portion of the parish, pushing a 25-foot storm surge that destroyed the parish levees. Almost the entire parish was flooded, with most areas left with between 5 and 12! feet of standing water...For more than two months after the storm, much of the parish remained without proper services, including electricity, water, and sewage.”

Some of the Acadian responders lived in St. Bernard, and while frantically trying to save themselves and their pets (see Jay Authement’s account in the “Animals” chap-ter), also worked tirelessly to rescue friends and neighbors.

**Jay Authement, Paramedic

We were going back and forth trying to help people out, driving our flatboat, going to different houses. We pulled out 20 or 30 people. Alex had a chain saw, so we were able to cut through roofs and get people out of their attics. We’d listen for the sound of people hollerin’ and we’d know which house to go to. They’d start hol-lerin’ when they heard the boats coming, they’d start banging on the roof, and we’d go cut their roof open and bring them through the hole. If you didn’t hear nobody hollerin’, you didn’t need to go to the house.

People were going to houses looking for bodies, going into attics. We went through every house, and while we were in these houses we’d take what food we could. The police told us, go to every house, and don’t steal anything but food. You want food; take whatever food you can find. So we did.

On Thursday, when I got with Alex, we had the two dogs with us, my dogs were al-ready turned loose in the house, and because of the surge we had speckled trout and redfish in our house.

A the sheriff’s office said, “We’re going to have a dump truck come down St. Ber-nard Highway to get ya’ll.” I had a pirogue, so we used it carry people out to St. Bernard Highway where they could get on the dump truck. Duke Collins was there, a policeman, so I went up to him and said, “Duke, it’s time for me to get out. I got to go. Get me some transportation out.”

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He brought me to Poydras where they had a barge. They put maybe 200 people on this barge, and everybody was dehydrated because of the heat. One of them was hypoglycemic and the only thing I could do was to find him some sugar. It was a miracle that we found any food or water at all. There were no IV’s or anything that the dehydrated people needed. And the people were turning red, and then there was this guy all pale and ashen, and he was so sick, but the most we could do at the time was give people water, what little there was to go around.

The boat came all the way up to Algiers Point, and when we got there, they had three buses that were taking some people and the rest of us had to wait for two hours. Eventually 14 buses arrived and they were loading people up, but nobody knew where they were going.

My dad, we got him out the day before. My father actually stayed in the parish be-cause they brought him to the Port Ship Service in Arabie, where they set up a tem-porary center for the elderly, so he had to stay there. Dad doesn’t know which way is up right now, because he’s all lost, and I didn’t know where they’d taken him.

I ended up getting on a bus and we headed out, but I didn’t know where we were going. Of the 14 buses, most had no restrooms; so we had to stop in Baton Rouge to use the bathroom. I went up to the front of the bus, and started talking to the driver. He said, “What you going to do after Houston?” I said, “What do you mean, Houston?” He says, “Well, we’re going to Houston.” I was shocked. “Houston? I’m not going to Houston.” He says, “Oh yes— Everybody on this bus is going to Hous-ton.”

By that time, the police started coming into each one of the buses with their shot-guns, not letting anybody out.

Well, I was fast enough to get out before they’d come in, and I said, “I am not going to Houston. I’m getting off this bus right here in Baton Rouge.” So I started walking, and when the police told me to stop, I didn’t stop. The people on the bus started getting rowdy because they wanted off too, so the police just started arresting them. While they were busy arresting people, I was able to sneak away. I got into the LSU main campus in Baton Rouge and I found a phone and called the 1-800 number to Acadian Ambulance switchboard. Amy answered, and she said, “Jay?” I said, “Yeah Amy." She said, “Stay on the line, hang on.” So she put me through to Linda. Oh my God, Linda was screaming and hollering by that point. She was in such a panic not knowing if I was living or dead.

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I’m going to move back to St. Bernard. We will rebuild. Insurance is going to pay for some of it. They’re going to have to bulldoze everything down, but we’re going to do it. We’re already buying stuff.

**Marc Creswell, Flight Paramedic

In St. Bernard, some office buildings that belonged to the oil refineries were being used as a shelter, and we tried to bring some relief to the people who had been working there for five or six days. They’d been eating box lunches for days and we really wanted to help them out, so we organized and called a few people -- includ-ing my dad who is one of the most resourceful guys I’ve every known -- and asked him to find us some food. We had a barbecue pit, and sure enough, my dad got a bunch of meat donated, and one of our Acadian vice presidents got some food do-nated from Outback Steakhouse. Somehow the St. Bernard parish president was able to round up some prison trustees to come and cook for us, and for many peo-ple working there, it was their first hot meal in six days. You could tell instantly that their morale boosted. We also got them some satellite phones and some other ne-cessities.

Oh yeah, and we got them some national media attention, which was really impor-tant.

Fox News was there but they weren’t really paying any attention to what was going on in St. Bernard and the other neglected parishes. I told the news guys, “If you want to pay $5.00 a gallon for gas, then go ahead and ignore this story. But if you want the refineries to get started up again and having those gas prices drop, you better do a story about what’s happening here.” Those little parishes weren’t getting enough news coverage, so consequently they weren’t getting enough help. We needed heavy equipment, mobile kitchens, volunteers and general labor, but no-body knew we were there. Fox finally did a story and let me to talk about this on the air for 2-3 minutes. And after that, the phone didn’t stop ringing.

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Organizing ChaosThis chapter follows Dr. Ross Judice during the first week after the storm passed — from the chaos of the Superdome to the triage area at Causeway & I-10, from the confusion at the New Orleans Airport to the FEMA search and rescue operations at the New Orleans Saints training facility. Two state public hospitals, “Big Charity” and University Hospital, along with Tulane Hospital and Veterans Administration Medical Center are located downtown near the Superdome.

Being thrown into the chaos of the Superdome was like being transported from quiet suburbia into inner city Bangladesh. While Acadian’s presence at the Super-dome was very small in comparison to the throngs of people and National Guard presence, we had a large impact on triaging, caring for, and evacuating patients.

At other locations on different days, Acadian led when needed and we supported when appropriate. At the I-10 & Causeway triage area, Acadian medics worked tire-lessly to triage, treat, and evacuate hundreds if not thousands. At the airport and in search and rescue operations we provided support to other agencies.

**Superdome, Tuesday & Wednesday

After I arrived at the Superdome Tuesday, Ray Bias20 took me into the loading dock area where there was trailer that was being occupied by some of the state Depart-ment of Health and Hospitals (DHH) staff and Dr. Fred Cerise, Secretary of DHH. Ray and I sat down and tried to get a sense of what was happening as they briefed me. There was very poor quality radio communication with the downtown public hospitals in and out of that location. They were trying to evacuate some ventilator patients from University Hospital by boat and wanted to transport them to the Clai-borne off-ramp at the Poydras exit. They were trying to send some ambulances to that location and the ambulances were having a very difficult time finding their way because of the flooding and the confusing spaghetti-like elevated highways. The command center was having a difficult time communicating exactly where they should go — was it the on ramp or the off ramp?

Dr. Cerise asked if we could re-deploy all of our ambulances (some 50 or so) that were at the Causeway and I-10 to that location. I got on the phone and talked with David Pierce21. We agreed that this was not a good idea since the State personnel

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20 Ray Bias is a nurse and manager for Acadian. Based in New Orleans, Ray played a key role in getting Acadianʼs Superdome operation organized.

21 Acadian President David Pierce was located in the Lafayette dispatch center.

did not have good radio communications. I did’t have much confidence in the State’s plan. We should not risk abandoning a triage area at Causeway that was working to move to a questionable staging area location with a no command struc-ture and no meaningful communications. David and I agreed that the ambulances would stay at the I-10 and Causeway, and that we would move ambulances once a downtown staging area was formed.

Dr. Cerise and his group called into a teleconference with Gov. Kathleen Blanco, state health officer Dr. Jimmy Guidry, state EMS director Nancy Bourgeois, and state trauma president Les Johnson. The information provided by DHH’s Superdome group to the governor was sketchy. The communication shortcomings affected their ability to survey the situation at the downtown State hospitals. At this point, there was no over-arching plan for all of the patients, both public and private, other than moving ventilator-dependent patients to the ramp at Poydras Street.

At this point all of the four downtown hospitals were filled with patients, staff, and family members. None had evacuated before the storm. All four hospitals had in-tensive care unit (ICU) patients - Tulane had critical babies. The state was definitely focused on the state hospitals. It was evident that there was no sense of the worsen-ing medical situation inside the Superdome.

After the briefing with the governor, Dr. Cerise, Ray, and I found New Orleans EMS Director Dr. Jullette Saussy and assessed the situation. FEMA's Disaster Medical As-sistance Team (DMAT) - a FEMA team of doctors, nurses, and medics from New Mexico - were setting up in the Arena and already had serious medical patients. These patients needed urgent air medical evacuation. I called our Erroll Babi-neaux22 and requested air evacuation of these patients. He informed me that there were two Petroleum Helicopters, Inc. (PHI) medical helicopters on the helipad. They had been there for two hours and nobody had given them any patients or any orders. The Dome was a big place and the right and left hands weren’t coordinated or communicating.

I decided to take charge of the air evacuation situation, so I sent Ray Bias with a portable radio communication to the DMAT area in the arena. Our medics in the first aid station and around the Superdome had radios. Some of us had satellite phones. We set up transport teams to move patients on demand. We borrowed some command vests from the National Guard Chemical Response Team. We set up a helipad/landing zone in the Dome parking lot because the National Guard was using the regular helipad and wouldn't let us use it too. We started moving the most critical patients out of the Superdome and Arena. This would be the beginning of a massive air medical evacuation effort.

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22 Erroll is Vice President of Acadianʼs Air Operations.

A PHI representative, Terry, and I organized multiple helicopter trips between the Superdome and Baton Rouge — a 90 minute round trip. The patients needing transport out were exceeding our ability to get them out. I decided to send the heli-copters to the Causeway and I-10 where I knew we had 50 ambulances. This was a 15 minute round trip flight. They could transport the patients by ambulance the rest of the way to Baton Rouge. The “short hop” flights were much more time efficient and moved so many more patients out.

All day the PHI air medical teams performed amazing work. At some point around dusk, seventeen ventilator patients from the VA Hospital arrived in big army trucks. We transferred them to helicopters with the help of some military guys, because the patients were very heavy. We had no spine board and they were on inflatable mat-tresses making them difficult to carry and maneuver. Those patients were being bagged, and some doctors and nurses accompanied them from the VA hospital. We loaded these patients on the helicopters as they arrived and evacuated them out to Causeway and 1-10.

Terry told me that his people were running out of fuel and the pilots were running out of flight time hours. We knew we would have to discontinue flights very soon, so we tried to get as many people out as we could. As soon as flights stopped, an-other big truck arrived with two more ventilator patients, one of them weighing 500 pounds. Since there were no more helicopters, I instructed them to transport the patients to the DMAT area. The DMAT people felt they could not handle these pa-tients, so I requested some assistance from a Colonel Keeling at the military post nearby. He authorized a few more trips on the Blackhawks for the critical patients who were still coming into the DMAT area, one I believe with a gunshot wound.

Flight operations shut down during the night on Tuesday. I treated patients inside the Dome all night and on Wednesday morning I went to the landing zone at 4:30 a.m. to wait for helicopters. I had every confidence that the world knew what was happening here and that any minute now we’d have plenty of helicopters. No heli-copters came.

Alarmed, I went down to the DHH command post in the basement of the Super-dome to see if they had a plan for air evacuation. When I arrived there, everyone was sleeping. I made a couple of phone calls on their satellite phone. Then I went on to the National Guard command center at the landing zone. All those people were sleeping as well, and lights were out. I could not believe that in this desperate situation that required a 24/7 operation, everybody was sleeping. Nevertheless, I trusted that the aircraft would come at first light. I lay down at the landing zone, unsuccessfully tried to get a few minutes of sleep, and waited for the helicopters to arrive so I could begin moving patients from the DMAT area as quickly possible.

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First light came and went on Wednesday, and by 8 a.m. the first helicopter finally arrived…but it was not military…it was Acadian bringing in relief staff. To my sur-prise, among the group that arrived on the helicopters were three of my brothers. Remi is a nurse. Roch is a communications engineer with expertise in satellite communications. Ronnie was a National Guard medic. With them were medics and doctors carrying medical supplies and equipment.

I got on the phone to Acadian CEO Richard Zuschlag and pleaded for as many helicopters as possible. After some monumental efforts on Richard’s part, the mili-tary helicopters - Coast Guard and National Guard Blackhawks - finally began fly-ing in at around 9 a.m. and never stopped until the evening.

In the beginning the military was real persnickety. They'd insist on taking exactly two stretcher patients and three walking patients, but we had one litter patient and eight walking patients, and they would refuse them! By the middle of the day on Wednesday we were just shoving people in wherever we could and ignoring the military’s rules.

I set up a tent near the landing zone to stage patients needing emergent evacuation. The patient flow was like this: our medics triaged requests for help among the tens of thousands of people inside and around the Superdome. Most were treated and released, while some were brought to the first aid station for IV’s, breathing treat-ments, oxygen, monitoring, or wound cleaning. The most critical patients were taken to the Arena on a “gator” or stretcher where the DMAT doctors and nurses treated and triaged to see who was evacuated next. These patients were transported down to the landing zone staging tent, and prepared for the next available helicop-ter flight out. Most were flown to I-10 and Causeway and transferred to ambulances for the hour long ride to Baton Rouge. Some were flown directly to the field hospi-tal on LSU’s campus.

At approximately 4:45 p.m. Wednesday I received a radio call from a colleagues who said that a FEMA representative wanted me to attend a command meeting. I rushed over there, and when I entered, there were many people, mostly military, and what looked like some high ranking officers from the National Guard and the Army, plus Mayor Ray Nagin and his entourage, and many others that I assumed to be junior officers of some kind. General Russell Honore was present, having just landed minutes earlier. The meeting centered on trying to figure out how school systems in nearby cities could be closed and their school buses sent to New Or-leans to transport people of the Superdome. Seemed like a good idea.

But nobody seemed to know whether it was Gov. Blanco or Secretary Cecil Picard who had jurisdiction over school buses, and this held things up for a long time. In

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my opinion, the Governor should have been called immediately and told about the school bus plan. She could have authorized it right then instead of wasting time ar-guing about who was in charge of school buses. The final task delegated in that meeting was that someone would “check with the governor” about the buses. Again, in my opinion the situation was way too desperate in the Superdome and this should have been an urgent decision. The buses finally arrived two days later.

General Honore asked, “Why can’t we walk these patients out of the Dome?”

An officer from the National Guard or Army (I think) reported that they had a plan to walk people out of the Dome, and another officer said that it could be easily done. Mayor Nagin was fairly outspoken about trying to create a sense of urgency about getting people out of there, and questioned why we were developing a new plan and what happened to the plan from yesterday? I personally did not know yes-terday’s plan, but it appeared to me that these changing scenarios irritated Mayor Nagin.

They addressed me only one time during the meeting, to ask me how many patients we had evacuated from the Superdome and how many more were left. My re-sponse was that I had no idea, because we’d evacuated them so fast that we hadn’t kept count. I also informed them that every minute that passes creates new patients because of the terrible conditions. The healthy people were getting sick, the sick people were getting sicker, and the sickest people were dying in there.

After the meeting Gen. Honore and Mayor Nagin met separately and I was standing with that group. I suggested to Gen. Honore that we should make immediate plans to walk the able-bodied people out. That comment seemed to register, but I re-ceived no acknowledgement from him or from anyone else. I might have been the only person in the meeting with first hand knowledge of what the medical condi-tions were like inside the Superdome. I wish that I would have spoken more authoritatively about the urgency of getting people out of those conditions, espe-cially the healthier folks who could have walked out, and alleviated the crowded conditions. I was also going on some thirty hours without sleep and that may have affected my ability to make an impression. I was exhausted and more than a little “loopy.”

After the meeting, Mayor Nagin and his entourage walked past my group of medics just outside the Superdome exit. I thought it would be appropriate for him to say “hello” to my staff who had been working tirelessly on behalf of the citizens of New Orleans. Frankly, we were all exhausted and in need of an “attaboy.” I ap-proach the Mayor, made an introduction and my simple request. He was downright rude, responding angrily, “I ain’t got time for that.” At that moment, I lost all respect for the man. He couldn’t spare five minutes!

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**Causeway & I-10, Thursday

On Thursday I flew from Lafayette over to the intersection of I-10 and Causeway. Our crews had set up triage there on Tuesday. The plan was for my team of seven to get off the helicopter and for seven weary medics board the helicopter for home. Upon landing, a desperate group of around fifteen people made a dash to get on the helicopter. I stopped the group to assess the situation and found out they were some doctors and nurses who had been stranded in flooded hospitals for days and were recently evacuated to the Causeway. I had to decide who got to leave on the helicopter and who did not.

After a quick assessment about who had been working the longest, I put seven Acadian medics on the helicopter. I met with the doctors and nurses and apolo-gized and told them that we would try to get them out as soon as we could, but that we needed to transport our own staff. We later put them on ambulances head-ing to Baton Rouge.

By Wednesday there had been rumors of murders and rapes in the Superdome, and the whole thing appeared to be completely insane, so we evacuated our people out on Thursday. I came home Wednesday night, got about 6 hours sleep, and Thursday morning I went back to the Causeway and I-10.

Acadian safety manager George Ellis briefed me. Austin/Travis County County (Texas) EMS was on scene and they had replaced our weary medics in the triage area. There were essentially four groups at that location: the State Police, Acadian (who had now taken a secondary role to the Austin group), and the Louisiana De-partment of Health and Hospitals’ staff. I introduced myself to Gordon Burg, inci-dent commander from Austin, and explained who I was and what I was doing there. I was awed by the professionalism and resources of his group. They had a state-of-the-art communications trailer with satellite links and internet access.

Gordon and I agreed that we should move the triage component to the New Or-leans Airport. It was not efficient to fly people in to the Causeway by helicopter and then shuttle them by ambulance a few miles over to the airport. It made more sense to fly people directly to the airport where they would be evacuated out of the area.

I thought the best way for us to move the triage team to the airport was using a two-phase plan. First the Acadian staff would move over to the airport and establishing a triage area. Then we would instruct the helicopters to fly directly to the airport, freeing up the Austin group to pack up and re-deploy to the airport. Gordon as-signed a medic named David to accompany me to do some recon and planning at

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the airport before we moved over there. Jumping in the supervisor sprint vehicle, David and I led a convoy of Acadian medics in ambulances to the airport.

**New Orleans Airport, Thursday

We stopped at the entrance to the airport where the Texas National Guard and se-curity were controlling traffic into the airport. Those folks informed me that the Na-tional Guard was trying to find out who was in charge so that they could set up their own staging area. I was transported by an airport security official up to the terminal area where I attempted to find out who was in charge at the airport. Meanwhile, David from Austin was charged with assessing the triage needs in the airport. The ambulances drove up to the terminal’s top level departure area.

Inside the airport I noted there were public strewn all over the terminal. One eld-erly lady sat in the terminal with an MRE in her hands. As I passed by her, she asked if I could open it because her arthritis was bad.

A DMAT team was set up in the downstairs Delta terminal, and another DMAT team set up upstairs. There was confusion by DMAT personnel about who was in charge of the entire medical or airport operation. We trotted downstairs to the DMAT area on the lower level to see what they knew about flights coming into the airport. I briefed them on the situation at Causeway & I-10. This DMAT team re-ported that flights were already incoming and that they were very well equipped to triage those patients coming in by air. By consensus we agreed that Austin/Travis County and Acadian would deploy on the top level to better organize the triage coming by ambulance.

As far as I could tell, no people were being evacuated out of the airport. My im-pression was that the airport was beginning to look like what I’d already seen at the Superdome: people coming in, piling up and no one moving out.

We had approximately 10-15 ambulances and a lot of staff awaiting directions. This, combined with the 10-15 ambulances that we brought from the Causeway meant that we now had between 20-30 ambulances at the airport. It had been my assumption that some patients would be flown in by helicopter and some would be bused in, and they would all be quickly evacuated out of the airport to whatever hospitals and facilities we could find. When I discovered no patients leaving by ground, and other ambulances from other services also staged there, I decided to send half the ambulances home and keep the remaining half at the airport. It was a waste of equipment and manpower for Acadian to have 30 ambulances just sitting there with exhausted crew members.

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I gathered all the medics in the Departure area near where the ambulances were parked, and told them that I was releasing half of the medics to go home. Some were relieved. Some refused to go. And some asked me, “Where are we supposed to go if the hurricane destroyed our homes?” I felt a huge lump fill my throat, paused to collect myself, and suggested that they go to the homes of family or friends where they could get some sleep and figure out the rest tomorrow. “If you need anything at all, get with Dee Dee and she’ll make arrangements.” Dee Dee Sewell, our employee liaison and critical incident stress manager, was there - thankfully. The heaviness of the medics as victims hit me like a ton of bricks for the first time since the mess started.

David from Austin came over to talk with me. He suggested I deploy a recently ar-rived Oregon DMAT team to set up the triage since that was their specialty. David suggested that the Austin group would be more useful in a forward field location, and would redeploy with a search & rescue team. I informed David that I had no authority over FEMA teams. He suggested that they were willing and ready to listen to anybody who looked like they were in charge. In David’s opinion, he thought that I carried myself in a way that showed I was in charge and that they would work with me.

With some authority, I walked into the DMAT command post on the upper level of the terminal and said I was in charge of the triage site over at the Causeway and wanted speak to their team leader. I essentially asked the head of the Oregon DMAT team to deploy and organize a triage function on the upper level where am-bulances were bringing patients. I was somewhat shocked that people listened to me, but it is clear they were looking for some sort of leadership and I filled that void.

A few minutes later Dr. John Jui and his staff with the Oregon DMAT team came over to our ambulance staging area to get more information about their orders and their deployment. I told him that I really had no formal authority but the upper level triage area was the greatest need at the moment. He agreed. I told him I was on my way to the FEMA Urban Search and Rescue (US&R) operation center over at the New Orleans Saints training facility and that I would be in touch. We ex-changed contact information.

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**New Orleans Saint Practice Facility - Thursday & Friday

Roger Brammell23 approached and said that he had been at the FEMA operations center over at the Saints Training Facility. Don Shawver, US&R security chief, was requesting that we stage over there and assist.

I took the sprint truck24 with Gifford Saravia, Jay Pierret, and three of the freshest ambulance crews and drove to the New Orleans Saints practice facility. Don wel-comed us and gave us instructions about where to park our ambulances, where the food was, where we could sleep, and where the operation center was. After getting some food, I went into the operation center. Dr. Michael Olinger briefed Gifford and me about the next day’s operation. They were planning to stage over in New Orleans East at the exit just over the high rise on I-10 near Chef Menteur Highway. Search and rescue teams would deploy along Chef Menteur Highway. They would go into the flood waters of New Orleans East to rescue individuals and bring them out.

Our ambulances were needed to transport any medical patients that were pulled out over to a collection site. There they would be triaged by a medical team headed by Dr. Ken Miller, US&R physician in charge of medical sector. From there the medical patient would be flown to the airport while all ambulatory people would be driven out by bus or truck.

The FEMA people told me that they were not able to access air medical transport for whatever reason. It didn’t make sense to me because — as federal emergency personnel — it seemed to me that they should be able to access military helicopters and even requisition civilian aircraft. I told them that I could provide some air sup-port through our dispatch center and through Acadian’s connections with the gov-ernor. In sum, my assigned responsibilities included organizing Acadian’s transport-ing patients to the collections area, where our people would also establish a land-ing zone. In addition, I was to use Acadian’s connections to obtain aircraft, pref-erably military aircraft. Gifford would lead our ambulance team deployed with the US&R teams and I would stay in the US&R Command Center in Kenner.

Captain Richard Smith with the New Orleans Fire Department sat with me for a while. He was under the impression that Acadian was going to inoculate all of the fire department staff for tetanus and hepatitis A. I told him that I was not aware of that, but I would do whatever I could to try to help him and his team. He told me

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23 Roger Brammell is an Acadian paramedic.

24 A sprint truck is a supervisor SUV equipped with lights and sirens.

that the firefighter personnel were a moving target - some of them were supporting Search & Rescue and others were going to be deployed to the Little Sisters of the Poor Hospital in Gretna. One of Captain Smith’s crew members sat down and told me about the non-stop tireless efforts of the New Orleans firefighters and what they had done to during and after the storm. He became tearful as he described wading through the flood waters to save families in distress. He and his colleagues went days without sleep. Only later did he tell me that he lost his house in the flood. I was impressed with his selfless sense of duty.

That night I attempted to sleep in the practice field where many of the medical people were sleeping. I lay down on the artificial grass but couldn't sleep because of worries about this whole mess. Since I couldn't sleep anyway, I got up to see what was going on in the command center and was surprised to find nobody there. I became increasingly frustrated, because I believed this should have been a 24/7 operation and there should have been people working day and night.

I didn’t understand why there was a briefing session scheduled for the next morning at 6 a.m. Why not schedule at 3 or 4 a.m. so people could be deployed first thing in the morning? They could have gotten into their helicopters and boats at first light, but instead, people didn’t get deployed until 8:30 a.m., and boats weren’t in the water until somewhere around 10 a.m. It was all so methodical and casual without the sense of urgency that Acadian demonstrated in its efforts.

At the 6 a.m. planning meeting they tallied up all the resources needed…trucks, MREs, medical staff teams, etc. There was a need for five ambulances and a Black-hawk to be ready in case there were medical patients who needed to be evacuated. I was assigned the task of taking care of the ambulances and the Blackhawks.

After the morning briefing at about 7:30 a.m., I told US&R planning chief Dan Hudson that it was very important that we assess the situation over at the airport and made sure that they knew that the US&R was going into New Orleans East. The airport rescue workers and DMAT teams needed to be prepared to receive more pa-tients and more evacuees. The estimates from the briefing was that the morning’s operation would bring some 3,000 new people to the airport. To my surprise there was no communication between US&R team at the Saint training facility and DMAT teams at the airport, even though they were separated by only a few miles. It appeared that they were operating in silos.

Mark C. N. Libby, the emergency coordinator for Region 1 in New England for the U.S. Department of Homeland Security National Disaster Medical System, and I drove to the airport. We would locate and brief the leadership about the search and rescue operation. To my surprise the population at the airport had increased from the day before. In my fantasy world I assumed that perhaps someone at the airport

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would have taken charge and started evacuating all of these patients in preparation for today’s influx of patients and general population.

There were people all over the place and, like the day before, it reminded me of the Superdome. I had grave concerns that if people weren’t moved out, there could be potential security issues and a huge bottleneck because Friday’s operations were sure to bring thousands more people to the airport.

During the 8 a.m. briefing at the airport, Theodore Monnette, the apparent head of FEMA operations at the airport, described the process by which the public and the medical patients would be evacuated. The meeting was attended by representatives from TSA (Transportations Safety Administration), the airport, U.S. Air Force, and others. Mr. Monnette appeared to be very calm and in charge and he engendered confidence in me. He explained that local law enforcement was going to move the public through the area to board the planes and that federal guard security was go-ing to be supporting them.

After the meeting Mr. Libby introduced me to Mr. Monnette and we all talked with the gentleman in charge of the medical part of this operation. We explained that we were part of the search and rescue operation and that we would be transporting patients to his location.

Returning the Saints’ training facility, I spent the entire day in the operation center with members of the US&R command team. It was clear to me that this was a very professional group. They knew what they were doing and the search and rescue teams were very professional and they knew what they were doing. This was later confirmed by the Acadian staff that deployed out with the search and rescue teams. All were impressed with their operation.

At some point a commander called out for the first helicopter. I got on the phone with John Zuschlag at Acadian and told him it was time to send the first helicopters in. He said he would call me back in 5 minutes. When he called back he said that the military had changed its plans and the search and rescue operation was no longer a priority. Instead, the National Guard helicopters were being used to drop sandbags into the levee breaches.

I told John that this was not an option. We'd just received word of a nursing home with 50-60 patients that needed those helicopters. Again he said he would call me back in 5 minutes. When he called back this time he said that the military was adamant that they would not send a helicopter.

I would not accept no for an answer. Again, he said he'd call back in 5 minutes.

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When he called me back this time he told me that he had a Chinook and two Blackhawks on the way. I felt very good at that point that we were able to help with this operation. It took persistence, begging and arm-twisting to get them to give us some helicopters. Thanks to John and others for getting those helicopters.

Erroll later told me that he had been in touch with Chief Warrant Officer Charles Tracy with the Louisiana Air National Guard. Through the efforts of Tracy, Colonels Keeling and Jenson at the Superdome, they were able to provide the Chinook and Blackhawks. The Chinook landed very close to the nursing home and was used to evacuate about 50 nursing home patients.

Looking back, it's amazing that FEMA allowed us into their operations without be-ing "federalized." They did it because Acadian was still able to influence the air op-erations. In other words, what FEMA couldn't do, Acadian could do. We could work with the civilian helicopter companies and the National Guard to get Chi-nooks and Blackhawks, but for some reason, FEMA could not.

**Lafayette & New Orleans, Saturday & Sunday

We began to work on getting supplies to the New Orleans EMS Service and Fire Department so they could continue their heroic work. While some medications were for patient care, most of the medications on the following list were for the medics and firemen because they left their homes during the flooding without their medications. The supply list tells their story:

Gatorade, Diet Coke, Coke, dental floss, citronella candles, regular candles, tetanus shots, Cipro eye drops, triple antibiotics, Bactrim DS, Benadryl, Lipitor, Diovan, Allegra, Lotrimin, tolnaftate, Cortis-porin, Vicodin, Cardizem SR, Zyrtec, Morphine, Epinephrine 1:10,000, Atropine, Albuterol, D50, Lidocaine, DEET bug spray, saline, lactated ringers, IV set ups, gloves of all sizes, HEPA masks, Hu-mulin, Novalog, regular insulin, syringes, Cosopt, potassium chloride, Silvadine, cardboard splints, bolt cutters, T-bars to change tires, “whore red" nail polish, BDU’s25, cargo pants and shirts or jump-suits in the quantity of 500 broken down into specific sizes, female underwear broken down into specific sizes and quantities, male underwear broken down into specific sizes and quantities, five to ten chainsaws, plus two-cycle oil, ten decks of cards, socks, sheets, towels, laundry detergent, bleach, boots…

We flew the supplies in two aircraft over to the Belle Chasse Air Station. With the help of Navy personnel, we loaded all those supplies from the hangar into two am-bulances and drove to the Little Sisters of the Poor Hospital. We found Ron Pelas, New Orleans EMS supervisor who appeared exhausted. He helped us figure out where in the facility the supplies need to go. Dr. Chris Najberg flew over with us.

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25 Battle dress uniforms (BDU)

He had helped at the Superdome earlier in the week. We turned everything over to him since he was staying to to help. We flew home.

Later that day, my initial contact, New Orleans EMS supervisor Jacob Oberman, phoned me to express his deepest appreciation. He said that when he saw the de-livery it brought tears to his eyes. Medical Director Dr. Jullette Saussy also phoned in and expressed her gratitude for the delivery. One of the items that we delivered was a box of hand, face and lip lotions that Martha Day from Teche Pharmacy gra-ciously put together in a box. Dr. Saussy told me when she received the box, “It made me feel human again.” She lost most everything in the storm, and along with her staff, worked heroically on behalf of the city.

Sunday, I was notified that one of my paramedics was reporting severe headaches, neck pain, sensitivity to light, nausea and vomiting that was fairly acute onset. He had recently been in the floodwaters and exposed to the muck of the flood. We sent an ambulance to pick him up and take him to the hospital, where the supervi-sor stood by his side as he was being worked up. All of his tests were negative, and he was discharged home. This was a very tenuous time. There was no way to know whether there was an infectious or toxic cause to his complaints. We did not know if we were facing large scale health problems.

We organized a team to provide hepatitis A inoculations and prophylactic antibiot-ics for all of our employees and first responders who had been in the flood waters. With no real precedent, we made up a prophylactic protocol that made sense to us. We were able to procure medications from Abbeville General Hospital, Lafayette General Medical Center, Women’s & Children’s Hospital, Medical Center of Southwest Louisiana, Iberia General Medical Center, St. Francis Cabrini, Huey P. Long, Opelousas General, Tom Day at Teche Pharmacy and Tina Stefanski at the Office of Public Health.

We put together an announcement to all employees about the immunization effort and developed an immunization alert provided information to the employees tak-ing these vaccines and antibiotics. It was a great effort by the Acadian education and quality team that pulled this together. They had to literally stuff Cipro or Leva-quin into little packets, print labels, print instructions and coordinate all those logis-tics to make sure that we were prepared to get this much medicine out to our staff.

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Difficult CommunicationsThe expectation is that when we call for help, help will come; that when a message is sent someone will be there to receive it. Arguably the most effective communica-tions model is the simplest one — a direct line of communication between a sender and a receiver. In the wake of Katrina, communication broke down and not much was reliable. The radio towers around New Orleans were down, civilian and mili-tary communication frequencies were not compatible, functioning communications devices were scarce, and there were no guarantees that there was anyone at the other end that even had the resources to help. Acadian personnel did what they were trained to do when they could, improvised when they couldn’t, and assumed authority when needed to do so. And it wasn’t just Acadian - a neighboring parish sheriff in New Iberia who had just received a big new mobile command center for such disasters showed up at our of-fice to help us re-establish communications. By Tuesday afternoon, he had his fifty foot tower up near New Orleans, his generator running and had reconnected Aca-dian’s system through a programmable channel to reestablish communications with Acadian’s radio tower over in Houma, Louisiana. We didn’t have all the bells and whistles, but at least we had basic VHF communications.

**Paul Fuselier, Paramedic

We had some communication problems. I think that was universal across the board. First of all, all your radio towers and everything were gone. Sometimes you had cellular communications; sometimes you didn’t. It was hit or miss. We had sat-ellite phones, but again, it was hit or miss. Inside the Superdome, communication was extremely limited. We did have some portable radios and we were able to talk with each other around the Dome. If one of us was in one area of the Dome and needed help, the portable radio communication helped out. But our biggest prob-lem was communicating with dispatchers and people outside New Orleans. It taught us that no matter how much we think our communications are in line, there is always something better we could be doing.

There's one thing we have practiced that I’m proud of. I call it “going back to the old school,” to the old days where you didn’t have all the fancy equipment. A lot of times we were doing local dispatching, which means we were dispatching our-selves. We have had radio towers go down before, and when that happens, the su-pervisor gets in his Sprint truck and goes up to the highest point that he can get to, and fields phone calls. When the towers are down we can go from unit-to-unit, but

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we can’t get from dispatcher-to-unit. And that's what we were doing during Katrina – dispatching unit-to-unit and trying to get crews where they needed to be.

When things happen you’ve got to go back to your basics.

**Billy Vincent, Paramedic

I was in the Superdome before Dr. Judice arrived with more medics, supplies, satel-lite phones, and some radios. The time we were without those radios made life ex-tremely hard. It was nearly impossible to coordinate between our first aid station and the special needs site at the other end of the Dome, which was manned by Na-tional Guard doctors, nurses, and medics.

Whenever a patient came into our first aid station and needed treatment that we could not provide, we would have to coordinate with the special needs site to get that patient moved over there (until the DMAT team arrived). But we had no com-munication, so we had to use people as runners. We'd send a runner over there to see if they could handle that particular patient, and if not, then how long before they could receive that patient. So the runner would come back and let us know, yes we can bring the patient, or no it’s going to be another hour. It was like the old Pony Express. People running back and forth delivering messages.

**David Trahan, Telecommunications Analyst

I was leading the pack of six trucks, and I was the first truck into New Orleans. Naturally, after a hurricane, you can imagine what we had to go through to get there – maneuver around downed poles, downed trees, low-lying wires, etc. When we got to the other side of the Mississippi River bridge, there was no way to get onto West Bank Expressway, and there were specific directions to go up the wrong way on the traffic circle. I wasn’t sure exactly what to do, so I pulled over into a gas station with all my trucks behind me and lo-and-behold up comes the National Guard and FEMA behind us. I didn’t realize that we had been leading the way for them. They apparently had no clue how to get to the other end.

When we got over to Acadian’s Gretna office, the first thing I found out was that we had no phone service. So I established phone service to the New Iberia Sheriff's Command unit. We were asked to go back down to the large triage area at the I-10/Causeway cloverleaf, where we brought satellite phones.

For the next few days, my job was to keep the telecommunications up and running. We were the only people with communications to the outside. The executive officer

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of the air base visited our command post and he was very impressed. For the next couple of days his people came in and used our phones until he got his satellite up, and even then we had a better setup than they did. We were told that we had a bet-ter command post than the naval air base or the army or FEMA.

We had Internet because of a satellite connection that CapRock provided, and a couple of guys from the naval air came over to use our connection. We provided them with the coordinates of particular houses that they knew people were in, so they could do these drop-ins and rescue people from these houses.

**Remi Judice, Nurse Anesthetist

Someone that was in control of what they called FEMA’s CA6-COM gave me a ra-dio. He said it was a Homeland Security walkie-talkie. It was yellow and it had “Property of FEMA” or maybe it was “U.S. Government” on it, and he made me sign a piece of paper saying I had that radio. He told me that if I misplaced the ra-dio or kept it, the FBI would come find me wanting to know what I had done with the radio. But I didn’t pay that much attention to any of that, loose cannon that I am, and I said, “Okay.” I signed my name, and communicated with him almost the whole night with that radio. When it was time for me to rotate out of there, I thought the helicopter might leave me, so I left the radio with someone named Surfer who worked for Acadian and told him that the guy at CA6 said if I lost this radio the FBI would come after me.

**Dr. Ross Judice, Medical Director

I was asked if I could fly to the Superdome to assess the situation and relieve Ray Bias. We went down there with some equipment and 30 or so portable satellite phones.

When we arrived at the Superdome the military wouldn't let us shut down the heli-copter. Ray was nowhere near the helipad, and the military was rushing us. It was very chaotic, and long story short, many of the satellite phones didn't get to where they were assigned. Because of the chaos of the Superdome situation, carefully laid communication plans to get the satellite phones to the appropriate people fell apart. This is the mantra of any disaster...despite careful plans – expect hiccups in the execution.

Thursday at the airport and FEMA Search and Rescue operation center, I was in contact with our dispatch center via the satellite phones. Communications were still difficult, and I couldn’t always get a line out on the satellite phone. My cell

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phone was not very usable, except in the middle of the night when there were fewer calls being placed from all over the country and the world. I was issued a FEMA radio and I also had our Acadian portable radio. But the Acadian radio did not work all the time.

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ReflectionsIt is said that hindsight is 20/20 vision, and certainly when it came to Katrina, dis-cussions about what should have happened and how things should have been con-tinue to this day. Most of those discussions are political in nature, and most of America has heard them all by now. What we haven’t heard are the reflections of the medics and rescuers, which cover a wide spectrum of emotions, beliefs and socio-political views. Here, after having some time to restore their bodies and souls, our medics look at their experiences in retrospect.

**Paul Fuselier, Paramedic

Had the flooding not been involved, the procedures probably would have run fairly well. But then all of a sudden 80% of the city is flooded, and that really changed things. I think we were prepared for what a hurricane does, but we were not pre-pared for what a hurricane can do when all of the sudden water is everywhere. It’s a different ballgame. I think that the floodwater caught us all by surprise. And once that came in, every plan went out the book. Suddenly everybody was trying to fig-ure out what to do.

It’s really hard to prepare for every scenario. And that is why we keep training. We practice these things, tabletop drills, and full-scale drills. That is why we keep prac-ticing because you never know what will happen.

There is a lesson to be learned, but not just for New Orleans. Don’t ever stop train-ing. When you do train, use different scenarios. A lot of emphasis has been put on terrorist attacks. But don’t forget about floods and the tornadoes and the other things. Train for plane crashes, for it all. You never know – you never know.

**Remi Judice, Nurse Anesthetist

On Friday, according to Ross and others, there were helicopters as far as they eye could see, like a swarm of bees, but this was five days after the storm, and this should have happened three days earlier. In retrospect, there was a lack of re-sponse, lack of communication at all levels, and according to the National Guard, their resources should have been used differently. In my opinion and there should have been more military involvement, because the hurricane was on Monday, and two days later I was there and there were very sick people that were not being mo-bilized out.

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That’s what I really recognized that whole time I was trying to get people on those helicopters, I should not have had to wait to see how many patients I could send off. I should have been able to send them all.

**Marc Creswell, Flight Paramedic

The scope of this disaster is just too big to comprehend. The hospitals didn’t figure on being flooded. Now we know that we need things like larger generators, gen-erators above the flood zone, pre-set plans to evacuate by buses, and back-up medical supplies. There are not enough resources in ten states to evacuate every one of those hospitals in two days.

We could have turned over the patients much more quickly if there had been a bet-ter plan for a large disaster. DHH came to help us after we struggled alone out there for two days, and we finally got patients to Terrebonne and to Laplace and other places. But prior to that we were flying them to Alexandria, Shreveport and Mon-roe. When you only have ten helicopters and you take one out of service for four hours to make a long trip like that, you cripple the operations. The military finally came in with those transports and they started a treatment center at the New Or-leans airport, and that allowed us to turn around real quick, but it bottlenecked. So the helicopters were sitting there for an hour trying to unload their cargo!

St. Bernard Parish, that little hospital, it’s a long-term acute care for patients that are pretty sick and they’re going to be for a long time and they need a lot of resources. They called us on Thursday when we were halfway finished with Touro Infirmary. So we commandeered a vehicle and went down there to find a bunch of patients with no way to get them out and no helipad. I don’t know what happened to them. I don’t know how they got out. I recall them saying that several patients had died, and they kept the bodies on the first floor of the building. I don’t know how many died there but there’s going to be other hospitals that will have a bunch of dead people. I don’t know how the rest of those people got out.

I know there needs to be plans for elevated helipads at every hospital with a census of more of 100 patients. There needs to be a plan where you can run at least half the hospital off of emergency power for a week. There should be provisions -- food and medicine -- in the hospitals to sustain them for a week. DHH needs to establish a team to organize that effort and secure places for those who present themselves at a hospital after a disaster. DHH is powerful enough to be able to tell hospitals 50, 100, 200 miles away, "Get your hospital ready – we'll be there in two hours."

This kind of thing is really taxing on medics and rescuers. I was on those rooftops, and it was 95 degrees. We were sweating for 15-18 hours a day. So many things go

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through your mind. You have trouble getting to sleep. You wonder if you did the right thing, and that lasts a long time. But I do know that we did everything for the right reasons. We did it because it was right. I have no regrets.

**Dr. Ross Judice, Medical Director

It’s easy to play “Monday morning quarterback” in situations like this. I can tell you the most glaring problems I observed first hand.

Lesson 1: Leadership and communications are the priority.There was no observable unified leadership structure (incident command) at the Superdome or airport during those first few days. The local leaders appeared to be overwhelmed, in many cases victims themselves, and lacked a communication in-frastructure. Louisiana officials onsite lacked immediately accessible resources and reliable communications. At the Superdome, the National Guard and FEMA seemed unwilling to engage the rest of us in any meaningful way. Because the Na-tional Guard wouldn’t give us any fuel for our Gators to transport, I had one of my medics steal some of the fuel when the National Guard wasn’t watching. On an-other occasion, I bartered with a National Guard officer for some fuel in return for the use of our ambulances. At one point a clueless FEMA official forced us to use FEMA radios despite having our own radios. Also, there is a common misconcep-tion that satellite phones will solve all communications problems during a disaster where the landline and cellular phones are down. Satellites have limits on their bandwidth and have the reliability of cell phones during a disaster. What I wit-nessed was this: no leadership, no coordination, no communication.

At times I felt that the Superdome and airport lacked what I call the “crazy muthaf***** in charge” who was the assertive, identifiable leader willing to corral the morass into an organized unit - that is, until General Honore arrived. Thank God for him.

Under FEMA’s own National Incident Management System (NIMS) protocols which all disaster and emergency services should use, a unified command system sets the criteria for leadership, communication, and resource and information management. While we train and utilize NIMS protocols and procedures for local emergencies like train derailments and bird flu, we were not prepared for a multi-jurisdiction, regional disaster hampered by massive infrastructural disruptions. During the first week of any large scale disaster of this type, the local resources are devastated, and the federal resources take time to mobilize and organize.

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Lesson 2: Government operates in silos and by the rules. Private citizens and companies reinvented the rules.While the men and women of the DMAT and Search & Rescue teams were incredi-ble, the different FEMA teams operated in silos during that first week. I saw this at the Superdome, the airport, and the FEMA US&R operations center in Kenner. Lo-cated less than 10 miles from the airport, the op center in Kenner did not commu-nicate and coordinate with the FEMA DMAT teams at the airport. FEMA individuals seemed determined to exert their authority without having a sense of what was go-ing on.

During the Friday search & rescue operation in New Orleans East, we found out that Louisiana Wildlife and Fisheries were conducting a search and rescue opera-tion in the same area — duplicating US&R’s efforts. FEMA was surprised to hear that.

FEMA couldn’t gain access to state National Guard helicopters for rescue efforts. In other words, there did not appear to be state and federal coordination of efforts. While the individuals working within government performed heroically, the bu-reaucracy stifled timely innovation and problems solving.

The military helicopters were so rule-bound that they operated inefficiently by leav-ing patients on the ground who needed to be immediately airlifted. Only by ignor-ing their rules were we able to evacuate as many patients as we did. We weren’t the only ones ignoring their rules. Doctors and nurses were turned away because they weren’t “federalized” (i.e., credentialed by FEMA to work in a disaster area), but that didn’t stop them. They found someone in need and helped them. Boaters from around the region snuck past road blocks to access the flood waters, and saved thousands stranded in their homes without food or potable water.

During a search and rescue deployment out to eastern New Orleans, the mile long convoy of trucks, trailers, boats and ambulances got a little lost. The first vehicle turned down a street that was clearly going nowhere. Every single vehicle behind them followed suit, except for the ambulances at the tail end of the convoy. They recognized that the only way out was for the convoy to wind its way back out to this same intersection, so they stopped and waited. A few minutes later, out came the lead vehicle with the rest of the convoy in tow. The ambulances jumped back on the back end of the convoy.

While this is an example of a simple mistake, the lesson looms large in the context of Hurricane Katrina. By following the rules so strictly, the well-meaning and highly qualified government or government-sponsored personnel often took unhelpful turns, while private companies utilized their resources much more efficiently.

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Innovation provided in real time saved the day. Acadian vice president Bill Vidaco-vich talked drivers of three large 18-wheelers into driving through the flood water to state-owned Charity Hospital. He and the Charity staff loaded 48 patients up in the back of those trucks and drove out of there. Somewhere, a state official was formulating a plan on how to evacuate those people who had been stranded for days. Bill didn’t need to form a committee develop the plan. Those desperate pa-tients didn’t have time for feasibility study. They needed innovative action, and they needed it immediately.

Lesson 3: The truth is hard to find during a disaster.Strictly defined, the “fog of war” is a term used to describe the level of ambiguity in situational awareness experienced by participants in military operations. The term is appropriate in the context of Hurricane Katrina. Lack of reliable information, the inability to communicate, and the fear and excitement of the event cast a cloud of ambiguity over the entire operation. At the Superdome, rumors of violence one minute were validated with actual violence the next. Exhausted minds tried to wrap themselves around the unreality of it all.

At one point, rumors led Acadian’s CEO in Lafayette to contact my wife, Robin, and told her that I had a mental breakdown and was sedated and returning from New Orleans in the back of an ambulance. Rumors of roving evacuees ransacking com-munities around Louisiana were common. Rumors of four feet of water on Bourbon Street turned out to be false — the French Quarter was spared from any flooding. These and so many other rumors were so far away from the truth but entirely be-lievable in this most unbelievable of circumstances. In retrospect, there were many, many cases of unjustified panic over various rumors.

Then there was the truth — a truth that was horrifying. People were suffering and dying, families were torn apart, and helpless children in the middle of it all. Sepa-rating fact from fiction is vital in disasters. We all remember the lessons learned in elementary school the teacher made us play the game called “Gossip”. A story is whispered to the kid on one side of the class, and that kid whispers to the next kid, and so on. By the time the message is relayed at the other end of the class, the story has completely changed.

This is not unlike what happened during Hurricane Katrina by well-meaning peo-ple. One night I called Robin to tell her I was all right. She had been sending out email reports of my activities to friends and families. Later we would discover that these emails were forwarded again and again. She began getting phone calls from around the country for information and offers to provide aid and resources. Among the callers were a U.S. Senator, a CEO of a major airline, a military official from NORAD, and journalists from major U.S. newspapers. The CEO of Dollar General called her to say he had truckloads of water coming into New Orleans…and

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wanted to know where to send them! She primarily served as a traffic cop by con-necting callers with the right people through Acadian’s evolving network.

Suddenly a storm of journalists called to find out about the massive number of deaths at the New Orleans airport. A journalist published this about the airport: “Ross Judice of Acadian Ambulance Services sent out an urgent plea for help at dawn Friday, when he said a meager staff was trying to care for more than 2,000 sick and injured patients, and eight to 10 patients an hour were dying.” It was re-printed in newspapers across the country. While I told Robin at dawn on Friday that the airport appeared overwhelmed, the rest was a result of playing the game “Gos-sip” - I think. Somehow the truth got stretched to the point of distortion.

In disasters, this distortion is the rule. Be aware of that and act based on the best information available.

Lesson 4: Medics can’t throttle themselves. They know only one speed – full speed.There is not a better group of human beings than emergency medical services per-sonnel - EMTs and paramedics. They love people, they love duty, and they love ex-citement. Most of all they love action. Hurricane Katrina provided all of this, and the medics responded admirably by throwing themselves completely into the fray without any concern for themselves. Many worked for days on end without rest, and complained when they were asked to go home for a break.

When I arrived at the Superdome on Tuesday, the medics who had been there since Sunday morning were manning the first aid station, caring around the clock for the thousands that arrived at the “shelter of last resort.” When I asked about rotating shifts, they looked at me like I was from Mars. They did not want to leave their posts. I would repeatedly see this dedication to duty over the next several weeks as Katrina, and later Hurricane Rita, would provide these medics and miracle workers with human suffering in need of care. The medics cared for patients hour after hour, day after day, and month after month over the course of two hurricanes and be-yond.

The last lesson is this: while medics are heroically caring for those in distress, somebody needs to be caring for the medics.

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EpilogueThis book describes a narrow slice of the Katrina story. As this book was being

compiled and edited, many acts of courage and heroism from rescuers came to light. These stories are worth telling. Perhaps some other author will begin the tell-ing where this one left off. After all, these are narratives in the context of an un-precedented historical event. It is my hope that this book inspires the telling, and serves as a reminder that human suffering can only be mitigate by human compas-sion and selfless service.

I regret that it took me so long to tell these stories. It’s been 5 1/2 years since Hurricane Katrina. I suppose life happens. I will say that I felt a duty to complete this project - a duty to those in EMS that serve heroically every day. I hope this book honors each of them and honors the EMS profession.

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