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Mission Brief - Tulane Evacuation

On Tuesday, August 30, 2005, LifeNet received a request from Tulane Medical Center in New Orleans to assist air medical evacuations from their facility. Their facility was completely isolated by water and no ground transport was possible.  Their lower floors were flooding and their generator was failing.  They had 140 patients including critical patients on ventilators.

 

LifeNet dispatched 3 aircraft: one from Huntsville Alabama ( 4 hours away); another from Atlanta Georgia (4 hours away); and the third from Tallahassee Florida (2 hours away).  We also sent one Program Director and one Regional Aviation Manager. Our Regional VP was going to coordinate from Denver.   Our fist aircraft arrived at 1800 on the same day.

Tulane in New Orleans was coordinating out of an EOC in Pensacola, and had a command post at Tulane as well.  We were requested by the EOC in Pensacola and told to call Tulane when we were 5 minutes out.  They had set up a helipad on the parking garage, a helipad that had never been used. To set this up they had to take down light poles and their maintenance staff had done an amazing job.

One of our aircraft arrived and did our first patient transport at 1830 (on Tuesday) from Tulane to Lafayette an hour away.  Our second aircraft was engaged on the same evening but we could not coordinate a patient transport because the helipad coordination.  It was obvious to our VP that Tulane could not effectively manage the helipad component of this operation with all they had going on.

LifeNet Regional VP re-assigned their Aviation Services Manager, John Holland and Program Director to the Tulane helipad to recon the situation, set up aircraft staging at off site locations for air assets as needed, and manage the helicopter traffic and helipad procedures.

Once our crews arrived, they found no way to set up off- site staging because there was no power, no radios and no cell phone coverage or any communications capabilities with the outside world. They were faced with a very large hospital that had no power to run medical equipment, no utilities, and no functioning elevators to get patients to the helipad.

They set up a large helipad on the top of a parking garage but had no way to contact the outside world except an occasional cell phone connection or messages sent through  helicopters that stopped on their way to other staging areas.

Our two managers stayed on the helipad for the next 60 hours until the last person was evacuated.  The HCA executive staff flew in to lead and be with the hospital staff during the evacuation.  They would not have been able to coordinate the helipad operation or know how to request and land large military aircraft if it had not been for John Holland, our Aviation Director. John is a retired U.S. Army Colonel who commanded entire  helicopter battalions when he was in active service.

Our aircraft participated in, and our staff managed the helipad for the largest civilian evacuation of patients from a hospital in history in conditions that were beyond horrific.  The toilets were overflowing with waste; the hospital had no air, fans or ventilation.  It was hot.  Dead bodies had to be left in rooms.

Over the 60 hours we were there, patents, including 400 pound plus patients, had to be carried down stairwells to a level where they could be transported to the parking garage and then loaded in pick up trucks and brought to the top.  All hospital personnel who were working on the helipad and staging patients had to be trained in hand signals for aircraft and in staging patients so they were ready to go. 

John Holland called military contacts and speaking in their language got a military response of large aircraft.  CH57, Black hawks, CH51s.  He also had all departing aircraft call on 121.5 a “mayday, all aircraft in the area respond to the latitude and longitude”.  In response to this mayday, several civilian helicopters who where just flying by New Orleans stopped and made several trips with patients that could sit or passengers.

The roof top crew had to coordinate quickly, hot- loading patients and passengers in about 20 different airframes that ranged in size  from a R44 (4 passenger) to a Chinook (50+ passengers).  At first the Chinooks would not put their full weight on the pad so they had to be loaded under the rotor wash of a huge aircraft.  This operation lasted for 60 hours. Ventilator patients had to be hand- bagged and some patients died while waiting to be rescued.  Here is an estimated time line.

Day 1 Tuesday August 30th. We arrived in the evening. We transported one patient before air evacuations were stopped at 0100 in the morning because of gunfire in the area. The helipad was unlit, uncoordinated and unsafe because the local flying area was very dark.

Day 2 Wednesday August 31st.  Our ASM and Program Director landed in the early morning to help assist in any way possible.  By mid day the Regional VP was uncomfortable because he lost communications with his team on the ground so he booked a flight to the area.  By that evening he arrived and got up to speed on the situation.  The “in” team refused to leave the people at Tulane and at approximately midnight the operation had to be shut down because of weather.  The “in” team had to wait at the hospital until the next day for more help.

Day 3 Thursday September 1st. 

Sometime on Thursday, John Holland asked his team of Tulane employees for the next patient. Their reply was “there are no more patients” and they all wept a cry of relief.  Now they had almost 1000 employees to evacuate.  Thursday evening they thought they were done evacuating patients from their facility.  A physician from the hospital across the street, Charity, arrived to plea for help.  He had 24 ventilator patients they needed to evacuate.  Charity had no place for helicopters to land.  The patients needed to be brought by boat across the street, then carried up the stairs to the helipad and evacuated from Tulane by the Tulane staff. Only a few remained when our night operations were cancelled. Military helicopters were operating in the area without anti-collision lights under night vision goggles and it was not safe for us to continue to operate in the same environment. 

Day 4 Friday September 2nd.  

The last remaining patients were transported in the morning by our early arriving aircraft.  They began evacuating staff a few at a time on smaller helicopters. The big military aircraft began to arrive and by mid- day the facility was clear of all patients and staff.  Our helipad coordinators rode out on the last flight. 

Evacuating people from Tulane. Staff leading group of people to helicopter

 

We had the honor of participating in the largest air evacuation in history.  I must believe that there is some guiding force in our world putting the right people in the right place at the right time. From the Executives at HCA who flew in to lead their group to the amazing efforts and coordination of Dave Smith at their command post in Pensacola everyone was in the right place at the right time.  For our small part, I believe if John Holland and Stiles Clarke had not been sent in to Tulane to manage the helipad, no one else with their unique skills and abilities would have been, and the evacuation would have taken much longer and more people would have died.

On a personal note, I have been a part of many disaster responses including hurricane Andrew and the Value Jet Crash. I believe the direct impact Air Methods and LifeNet made was the largest contribution to avoid human suffering and preserve life in one incident of any organization I have belonged to. 

Attached below is a perspective written by an executive of Tulane who experienced the ordeal. The reference to John Holland and the “man John” is our South East Regional Aviation Services Director. Bold and photos were added by me.

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I thought it might be easier to compose an email to all of you at once that tells some of the story of the past few days.  First and foremost I felt your prayers and heard your concerns that were registered with Donna and others and they comforted me and kept me calm which was essential in this time.

In Dylan's song, A Hard Rains A-Gonna Fall, the singer is asked the
questions of where have you been, what did you see, what did you hear, who did you meet, and what'll you do now, my blue-eyed son to which he answers with a collage of images of his experience that attempts to answer each question.  In this crisis the images were moving so fast that I think it'll take awhile to put it together but here's an attempt to do so.

This storm as of noon Friday the 25th didn't seem like it would be much of an event, but by 5pm things began to look different.  We met as a group on Saturday to begin our routine preparations for a hurricane.  Donna left for her brother's home and I went home to put things together there.  I started to think what do I absolutely not want to lose in case the house would be swept away and the answer only revealed the photos of the family thru the years so that and few clothes was all I took.

The Storm:  God's Natural World has an awesome power.  From the small
observation windows from our tallest floors, we observed awnings being blown off, a blinding rain and a general sense if God's ever angry we're going to lose big.  Our first inspections revealed little damage.  A few broken windows and some roof damage but the building held up well.  In fact, if you were in the inner core of the facility you only vaguely heard it.  We even walked around late in the afternoon since there was only limited flooding no worse than a heavy thunderstorm.  Overconfident, we even stated we had absorbed the best punch that nature could throw and we seemed intact.

At 1:30 am on Tuesday morning began the biggest crisis and challenge of my life and in the life of Tulane and no doubt New Orleans.  I was awakened by my COO who told me the water in the boiler room was rising a foot an hour since midnight and if it continued at that rate at best we had only another two to three hours before we would lose all power since we already were on emergency power since early Monday morning.  We had only 7 ventilator patients whose lives would be in jeopardy, and we had to move fast to get them out.  We had no boat and no helicopter pad.  Houston we have a problem. I called Acadian Ambulance (who I know well) but had no business connection to our hospital and asked their immediate help.  We have a parking deck connected to the hospital that we had evaluated as sturdy enough to support helicopter flight, but it had four light poles in the middle.  I want to tell you what happened in the next four hours was nothing short of a miracle.  Our maintenance group got the light poles down; Acadian agreed to pick our patients up, we made arrangements with our other HCA hospitals to take them. Our staff and physicians got their patients ready, and most importantly, the water rise began to slow to an inch/hr and a little after the sun came up copters were on the roof and patients began to be transported.

Early on Tuesday morning we met with our key managers who were at the
hospital.  We prayed for support and comfort and guidance for what we knew was going to be a difficult period.  We talked about what we knew, and what we didn't know which was considerable because we had no contact from FEMA or the Mayor's office.  We had no idea why the water was rising and from what limited facts we had, no one did.  We had to assume that it would keep rising and we would lose power and then we would have no power at all.  Thus, no light, no ac, suction, oxygen, elevators, phones ie. Everything that is precious to good care.  We had to get out so we hatched a plan and I tried to stay out of the way and let our physicians and nurses triage patients; others determined what vital supplies we needed replenishing; HCA was working frantically to coordinate a transportation effort to pick up patients and eventually, our staff.  How many people?  Good question. At least 1200 which included a total of 160 patients, employees and physicians and their families and 76 dogs and cats that I didn't know about at the time.

Tuesday:  The looting began.  We witnessed people, dozens of them, wading in front of the hospital with bag after bag of stuff from different stores in the vicinity.  Bandits took over two hotels adjacent to us and forced out many of our employees families who had been housed there forcing them back to the hospital creating further complications.  That night our people on the roof evacuating patients heard gunshots in the air but they continued their work. The flawlessness and insurrection certainly was a distraction but our Tulane Police were great, and they are very capable. Late in the day we ran out of fuel so our generators shut down and the building began to get hot.  The last of the ventilator patients had to go up six stories by way of pickup trucks since the elevators shut down and our ambulance was too tall to squeeze to the top.  During the day, I had a conversation with a patient's father who told me that the parking deck pad would hold big helicopters.  How did he know?  Because he was a Blackhawk pilot.  Ok. Then there appeared out of nowhere this guy, John Holland, who was sent in by HCA to be our Flight Coordinator - whatever that is.  "The man" had arrived who would communicate with the birds in the air and boy is that important because our patients had begun to fly away.

Wednesday:  If you would like to know if we slept.  Here's a little
experiment.  Try heating the bedroom up to about 90-95 degrees.  First,
you're hot and then you sweat and get cold and then the cycle repeats. 
Daybreak and I tell you patients are being moved into a queue to move. I saw our staff, residents, and faculty move sick patients with a grace and dignity that was most impressive.  This was our third day and the stress on our people began to show.  Everyone was asking when, where, & how were we going to get out.  The city sewer system was obviously backing up and spilling out and creating an acrid smell that over the next few days made it almost impossible to breath. With no water pressure you can't bathe. But here's a general observation:  if everyone smells the same you really don't notice it, you just feel unclean.  On this day, the La. Wildlife and Fisheries Department showed up to help us move some patients that we had inherited from the Superdome on Sunday night.  Yes, over 60 extra medically needy people with chronic conditions.  So by boat we sent them and their love ones away.  I met a woman whose most valuable possession was her pillow and her radio that I personally promised her to protect.  It's in my office now.

The Big Birds began to fly.  Blackhawk's down.  Instead of one or two
patients they could move up to four with some additional staff. Beautiful sight but there was more to come.  By the end of the day we had moved all but about twenty patients including two who weighed more than 400 lbs and one artificial heart assist-device patient, which was the challenge of the week since the device itself weighted more than 500 lbs.  So imagine hauling this weight three to four floors down a dark stairwell at 90 plus degrees.  It was a young man's job and it was done.  Let me tell you that the coordination from the patient's room to the staging area to the helipad into the helicopter was a work of art composed by many painters.  It truly was a thing of beauty and it touched everyone who was there.

By the end of day, HCA had constructed an extraction plan for the remaining staff.  Helicopter to the airport, buses to pick up and take to Lafayette.  Sounds good but there were lots of needs and who knows what the government may decide to do.

Thursday:  Line up and get ready.  Have a little breakfast.  We basically were living on Strawberry poptarts, honey oat bars and for dinner a little protein, tuna fish.  Fortunately, I like all of them but I'm sure I lost ten lbs. or so.  Anyway, the line was formed and I personally counted.  700 hundred people. Our staff, physicians, their children and spouses, and just to top it off 76 dogs and cats.  Holy God.  How are we going to deal with that? So we relegated them immediately to second-class citizenship to another line and pray we don't have to put the pets to sleep if no one will haul them.

At first there were just a few small copters and we had some patients to move and it was slow.  Moving through the line people were calm with a few exceptions but overall they managed their plight well.  Then a situation developed.  A frantic Medical Director of Critical Care showed up by boat from Charity.  Major problem.  Charity was in a meltdown.  He had 21 critical care patients many being hand ventilated for two days and he couldn't get any help from the state.  You may have heard this story reported by CNN.  Their version and ours differs but raise your hand if you think the media gets it right all the time.  Can you help me he asked? This was a tough question but it had only one answer.  We would give them access to the small aircraft, which wasn't going to help us move our staff anyway. 

So that process began much to the chagrin of our non-professional staff and family.  They just didn't understand it.  Our nurses and doctors did but it increased the crowd's intensity.  Midday and it was moving slow.  It didn't look good.  Then from 3 to 5 things happened.

A Chinook helicopter is big.  Two rotors and it carries about 50-60 people.  It moves with a slow deliberate confidence that is hard to describe. But one showed up.  We had questioned about could it land so we asked "the man, John" and he said yes but nothing else could be on the pad when it did due to the turbulence.  I want to tell you as it approached cheers broke out from below and people thought they had a chance.  So for a few hours we made big birds, big problem.  What
happened?  Don't know.  I called my daughter Megan where Donna was staying and she seemed elated.  "You're back".   "What?" I asked.  She tells me Gov. Blanco had just announced that Tulane had totally been evacuated. According to my account she was about 400 people short in her analysis.  But we now had a new problem.  They think we're not here.  Better let someone know. I called the La. Nat'l Guard.  Guess who answered, Brad Smith, the patient's father I spoke of earlier.  He had gotten a ride back with some of the Wildlife boys and was now flying sorties into New Orleans.  He quickly got a hold of the Office Of Emergency Preparedness and let them know we still needed help.  So maybe Friday we'd get out.  People were remarkably calm when we told them they'd be there another day.  The just sat down and began to prepare to go to bed.

We left the hospital and remained in the parking deck.  One it was cooler, two there would be less confusion in the morning and three it was safer since there was less territory for our Tulane Police to patrol.  I know the media has played up the anarchy, and no doubt there was some concern, but I always thought we were safe.

So imagine trying to fall asleep on your concrete driveway without a pad or pillow.  It's kind of tough.  Then throw in an unexpected helicopter landing at 1 am.  The wind is a little dicey.  The bird dropped off 50% of the Marines in New Orleans.  One guy who need to go to Charity so we had to take him over.  Next event for the evening: at 4 am we were treated to a massive explosion at a warehouse on the river several miles away.  I happened to be looking directly at it at the time.  It must have reached a 1000 ft in the air.  Then by the end of the evening we began actually to get cold.  But it finally ended.

Friday:  The end is pretty anti-climatic.  At 8 o'clock unexpected Chinooks began showing up taking 60 people at a time.  I wonder if our pilot friend in the Guard had anything to do we it but I haven't asked him yet.  So in a matter of 2 1/2 hrs. everyone was gone but our Police and the last remnants of management.  So after attempts to arrange a coordination with Charity to use the helipad, we left for home sweet home.

Obviously, this is only phase one of a complicated recovery for New Orleans. Each of you no doubt is praying for this recovery.  So many people have lost so much and it reaches far beyond New Orleans.

I talked to the Chairman of the Board of HCA yesterday upon returning and told him it was the worse and most difficult challenge I have ever been personally involved with but at the same time I don't think I've ever felt as great a sense of accomplishment from anything I've been involved with. Our staff performed like clockwork and it was a beautiful thing to observe.  Our success in this week is simply measured by the fact that we didn't lose a patient during this trying time.

Jim

P.S. This event is just below a nuclear catastrophe in its degree of
magnitude, and it's clear we're not ready and if we don't do better the next time a really hard rain's a-gonna fall.”

Mission Brief – Triage Hospital Evacuation

Mission: Evacuate patients from field hospital at New Orleans Airport.

Saturday September 3rd 2005.

On day 5 of our mission we knew there were a large number of patients being taken to and from the field hospital that was set up at the airport.  Their was no command and coordination of Air Medical resources.  I advised Stiles Clarke, Program Director from Huntsville to recon the Field Hospital.  I was dropped off at the FEMA Urban Search and Rescue Command Center to recon what was happening and get a feel for where we were needed, if at all.  I had worked with this group when I was on a USAR Team.  At this point, we did not know if there was anything left to do.

When Stiles arrived at the field hospital at the New Orleans International Airport he found a large refugee camp set up outside and a field DMAT  hospital inside.  The civilian helicopters were fueling across the runway coming over to one side of the terminal and waiting for patients to fly out of the triage hospital.  On the other side of the terminal was a line of huge aircraft, Chinooks, Black hawks etc... off loading people who were then being either sent in to the hospital or to the refugee camp. 

Military dropping off on left and civilian taking out on right

There was no process to stage and have the civilian helicopters get assigned a patient.  Basically once in the waiting area you would just sit there unless you were aggressive and went in and forced someone to give you a patient. 

Stiles met with the FEMA DMAT leader (who was Morice Brazil former Program Director of Bayflite) and suggested a system of staging patients and helicopters to be sure the helicopters were being assigned in an orderly and fair manner.  He accepted Stiles plan and two people, one from Acadian Ambulance and one from PHI helped to set the system up.  PHI had decent communications so staging could be set up across the runway at the fueling stop and helicopters were brought over 4 at a time.  Once in “staging” the plan was one crew member came in and received a patient and then accompanied an AMR ambulance from the hospital to the helicopter.  This plan worked well for this day. 

Our helicopters participated in this mission for the rest of the day.

At the FEMA base I was able to direct some of the helicopters in staging to scene requests that were occurring as the USAR people were pulling people out of the debris.  There were some problems since the staging area or I did not have reliable cell coverage or communications.  They thought having a medical helicopter based at their command center had value and I left at the end of the day not expecting to be back.  I left them the phone number for the local helicopter service and my cell number in case they needed anything.

When we all left the area, the plan was for Stiles team to be back in place early in the morning to set up their system again.  I was going to work in the rear the next day.

Saturday September 4th 2005.

Our helicopters got an early start and were at the hospital by 0800.  There were very few civilian helicopters there and the team from the day before was not there.  Acadian had apparently had a meeting and told everyone to stand down, they could handle it form here out.  Since they were coordinating FEMA funding, everyone else pulled out.  I did not know any of this and around 0900 I called Acadian.  They said they forgot to call me.  I advised them we were on site as planned and they said they would include us in the day’s missions out of the field hospital.  That day we were busy flying patients out of the field hospital but because of the few number of civilian helicopters, staging was not an issue. 

In the afternoon, I was called by the FEMA Command post who ask if we could respond to a scene request. I checked and had communications with out aircraft and they were at the Airport so I advised them we could take it.  We performed the flight without problems.  FEMA called me back and said they really needed a helicopter at their command post because the local civilian operator, Acadian, was not Critical Care and was overwhelmed and not basing a helicopter in the area.  They had had a USAR Rescuer hurt when a Chinook blew a pallet which hit him in the head.  He was seriously hurt and there was no one to take care of him from an air medical perspective. 

We received an official request that evening to provide a stand by aircraft for their command center.  The mission priority was:

1. USAR Team member medical evacuation if necessary.
2. Rescue victim patient transport if patient needed medical interventions
3. As a last resort, logistical support for USAR Command post as needed.

 

Mission Brief – FEMA Urban Search and Rescue (USAR) Team Support.

Mission:
 

4. USAR Team member medical evacuation if necessary.
5. Rescue victim patient transport if patient needed medical interventions
6. As a last resort, logistical support for USAR Command post as needed.

Monday September 5th 2005. – September 18th, 2005

Aircraft reported to USAR Incident Strike Team Command Post.  One was staged there to support the USAR mission and one was still assigned to the Acadian mission.  We continue to have major communications problems.  No one has radio base stations to communicate with the aircraft in the air from our command post.  We are relying on the unreliable cell phones to give us a call at each stop of an aircraft.  Several times the location of a patient was changed or the Lat/long was wrong and we had no way to let the aircraft know.  They had to fly around in frustration until they gave up and returned to base.

The FEMA USAR mission was critical, protect those who are rescuing.  The elite Urban Search and Rescue (USAR) group that is still searching New Orleans has tasked LifeNet to provide coverage for their team in case one of the members needs air transport. They are also on standby in case the search teams finds patients that require medical interventions and air transport. The mostly military presence has limited if any critical care ability. Shown here is the LifeNet EC135 at the FEMA USAR Command post where they are stationed.  LifeNet is currently tasked until September 18th in this mission.

The crews felt a little frustration at not flying a lot of patients.  They wanted to doing something in the midst of this tragedy and standing by felt like wasting time to them.

On September 16th, 2005 USAR began doing secondary searches.  To this point they had not been able to force entry to houses to search, but now had permission to do so for any house that had more than 5.5 feet of water in it.  In this secondary search many bodies were found, some in houses that had been checked from the outside several times before.  In one of these houses a 71 year old man who was a diabetic was found alert and oriented and was transported to the hospital by LifeNet. This man had been trapped in his house, staying in the attic for 16 days with limited water and no food. 

 Now that the search had intensified, and the weather was hot, on the same day LifeNet also transported a USAR rescuer that suffered from heat stroke. 

At LifeNet at Search and Rescue Command Post Command Post

 

 

 

Mission Brief – Mississippi EMS Support Aircraft

Late Monday afternoon on September 26th, 2005 LifeNet was requested by FEMA to provide EMS helicopter coverage for the worst damaged areas from Hurricane Katrina in and around Gulfport MS.  On September 27th, 2005 LifeNet had an operational aircraft in place with crews for 24 hour coverage. 

The area, which includes several barrier islands infrastructure was devastated.  Bridges are out making ground transportation difficult and prolonged.  Helicopter transport is key in maintain an acceptable level of emergency medical care to this area. 

Some hospitals were destroyed and tent field hospital are in place.  These tent hospitals can not do any tertiary care so rapid helicopter transport is necessary to get patients to definitive care.

LifeNet crews are living in dormitory environment with local ems providers, sleeping on army cots and eating three meals a day at the ‘camp” cafeteria.

This aircraft is being set up for long term coverage of this area.