Search and Rescue in the Wake of Hurricane Katrina

9/12/05
I was deployed to New Orleans with FEMA on Saturday the 10th. Although the NY Times reported three days ago that search and rescue efforts are over and that the operation has switched to body recovery, this is far from the truth.

Earlier yesterday, we made entry into a house and found a 91-year-old wheelchair-bound woman calf deep in water. After 13 days trapped in her house, her legs were in very poor condition and she was very dehydrated, having run out of water 4-5 days earlier. With some wound care on scene and a helicopter transport out, she was in a hospital. Each rescuer got a kiss on the cheek. This was followed by a more complex extrication of a wheelchair-bound 350-pound woman from her house. This required the partial removal of a wall.

Of the 22,000 or so rescues reported for the four states during this hurricane, FEMA US&R [Urban Search and Rescue] teams have performed about 6,500 of them. As with 9/11, we have used every search and rescue task force in the national system. Entering this operation after two weeks, I have still had to jump in at full speed, as this is still the pace of the rescue effort. I cannot even imagine how difficult this was for the people here in the days before any power or communications were available and thousands of evacuations happened each day. We're down to dozens of evacuations a day, and it still seems like a dizzying task.

Highlights:
• We're now in the process of a house-by-house search of every house in New Orleans.
• FEMA US&R teams are assisting with the extrication of the entrapped dead bodies.
• We are working out of the New Orleans Saints training facility...housing 2,000 FEMA, military and National Guard personnel.
• Decontamination procedures for the highly polluted waters are a major medical issue for our rescuers.
• Roaming packs of dogs are becoming an increasing hazard for rescue personnel.
• Only three hospitals in New Orleans are open, and I have been helping with the Public Health Service evaluation of Charity Hospital in attempts to get that open as soon as possible.
• We still do not have potable running water, and are trucking it all in to our site.

My helicopter flights over New Orleans have left me astonished at the size and scope of the devastation. The massive displacement of people and damage to this city is almost beyond comprehension - even as one flies over staring at it.

More when I can.

Hernando

Update 9/13/05
Another busy day.

We are very close to done with a hands-on primary search of every residential unit in the city of New Orleans. Several other live rescues occurred today. Rapidly decreasing water levels have facilitated the search.

[Regarding]...illnesses and injuries of US&R personnel. Aside from minor ailments, so far we have had only three trips to the hospital, and one rescuer admitted overnight. This is quite good when considering that over 1,700 workers have been doing very physically strenuous and sometimes risky work in 100 degree, humid heat - a testament to the vigilance of our US&R medical teams.

Managed to attend a Public Health Service meeting at one of the three open hospitals where the main topic was transitioning from response to recovery - getting the local community health system back on its feet. The military, PHS, and FEMA medical personnel are still working to get Charity Hospital open within a week.

I have also been in contact with the other Kaiser medical relief workers stationed in Houston helping with refugee care. They seem to have had a productive first day.

Attached pictures show...:

-a street where water levels are decreasing, but ( there 's) still no ... easy access.

-Abandoned car - the street has already dried..., but the damage is evident, as are the spray paint markings from our search teams that show the structures have been searched.

More when I can,

Hernando

9/16/05
Yesterday...our rescue teams completed a primary search of all residential units in the city of New Orleans, and are now starting secondary searches of the areas that were under deepest water. The water continues to recede about 1 foot per day making our search activities easier.

In the morning, I attended a meeting at the Emergency Operation Center (EOC) of New Orleans, which has only recently gotten up and running.... The current medical issues include getting the 911 system back up... in anticipation of the return of residents. There are also many huge and politically controversial issues around getting certain hospitals up and running again - hospital staffs that want to re-open as quickly as possible; state officials that want the hospital razed to the ground and re-built with federal funds; and so on.

After the morning at the EOC, I made a site visit to the Aircraft Carrier Iwo Jima. The ship has been here since Sept. 5th, and is coordinating all military aircraft. They still do a large portion of our helicopter traffic and almost all of our medivacs. They have a medical crew of 15, a 17-bed "ICU," can run 4 O.R.'s, and carry 600 units of blood.

The excitement for the day included a two-ton coast guard truck with 12 personnel that rolled over while driving through flood waters. Our search and rescue teams came upon the scene shortly after the rollover happened, and orchestrated the rescue and decontamination procedure.

After visiting the Iwo Jima, I managed to... check on the house of a friend's father. It is in one of the hardest hit areas, and residents are not expected to be allowed back for four months (the parish president is hardly letting in rescuers). With the flood waters receding from their 8-10 foot max, the mud in the streets is up to a foot thick in places. The cars that were thrown on top of other cars or against houses, and the houses that sustained structural damage were further damaged when the flood waters came in a day later.

I have been comparing the images from photographs of refugees stuck in the streets of New Orleans, awaiting evacuation in the first few days after the flooding, with the ghost town through which I now drive. Currently, aside from the relief workers, military, and cleanup crews, there are almost no residents. But the evidence of the suffering and displacement of people lies everywhere. Almost every elevated freeway, and areas of high ground where people gathered to escape the flood waters are littered with blankets, clothing, children's dolls and strollers, personal possessions, stranded cars, and more.

Hernando

9/17/05 update
Our live rescues have decreased sharply last week - 64, 32, 12, 8.

The 15th was the first day with no live finds. So yesterday we all got a huge lift when we found one more person alive - the story made national news, and you may have seen it. This was a 71-year-old diabetic, still wearing his last two hospital bracelets on his wrist, who had not eaten in 16 days and was surviving on sips of water from a 32 oz cup. He survived the initial flood by living in his attic for over a week, and only went to the lower floors as the water receded.

We are... rotating teams out. Having already used every team in the system, we are sending home five California teams over the next four days, and are calling back four teams after only a week of rest at home (TX, MO, FL- 1, and FL-2). We are still pushing hard to complete secondary searches (entering houses) in hopes of additional survivors, before we consider the search and rescue phase over. In the process we are also coming across more deceased (or human remains, H.R. as they are called).

The heat index was 110 degrees today - hotter and more humid than days past. Heat illness is still a major concern with our rescuers, but we have not had anyone retire early from duty in the past few days (the health and safety measures seem to be working). We have developed personnel decontamination procedures that are now being followed by the state and local government for all other workers in the area.

Today I also got another chance to go on another reconnaissance flight (picture of me exiting said aircraft enclosed). This was a 60-minute flight and included all of the affected greater N.O. area. The damage is breathtaking in scope - not much more can be said.

The highlight of my day, however, was visiting the only restaurant that anyone has heard of that has stayed open during this disaster. They have been using bottled and boiled water, and have been open from noon to 5 p.m. serving free meals to 2,500-3,000 rescuers daily. They have been working 8 a.m.-8 p.m. with a skeleton staff every day. It's the best meal I've had in weeks. By the way, this restaurant is run by Anthony Occhipinti's parents. (picture of the front of the restaurant is enclosed.)

Hernando

9/20/05 update
The 16-hour days continue. And the rescue efforts go on as well. We are down to five Urban Search and Rescue (US&R) task forces, as the Texas team has been sent home early to prepare for Hurricane Rita which is most likely to strike Texas as a Category 4 Hurricane. The director of the Hurricane warning center has told top FEMA officials that Rita could be as bad as Katrina.

This has complicated our work on many levels. We are continuing search and rescue efforts here, but also making evacuation contingency plans in case Hurricane Rita turns more towards New Orleans. The Corps of Engineers say that even a Category 3 storm now would result in catastrophic failure of the New Orleans levee systems again.

In the meantime, the labor pool for our US&R teams (doctors included) has been stretched to the maximum. FEMA has sent a skeleton Incident Support Team and has activated nine US&R task forces in anticipation of Hurricane Rita.

In the last few days I have been working on a variety of issues including:

-coordinating better ambulance coverage for our search teams in the field

-clarifying the air medivac process which is still through the military

-establishing a clear and easy reporting system for animal rescue (our teams are finding many live pets)

-establishing treatment guidelines for puncture wounds and other injuries that occur in this unusual work environment (I even asked an Infectious Disease specialist from my own hospital for help with this)

-working with CDC and UC Irvine to create a post-deployment health surveillance questionnaire for all task force members

I got a chance to tour the area most ravaged by a broken levee where blocks of houses were simply torn from their footings and washed away (the 9th ward). To stand on that levee and look over the sea of ruble gives a perspective on this calamity that the scenes on the television do not.

Life is simply so fragile. Despite how we seek comfort and security, life is at its essence uncertain.

Thank you all again for your support and kind words.

Hernando

9/23/05, 1:20 p.m
For the last several days we have been making contingency plans for the arrival of Hurricane Rita. Our evacuation plans to travel north are already set - vehicles fueled and stocked with MREs and water. If winds are sustained at 75 mph, we will head to Alexandria, LA.

We put rescue teams in the city of New Orleans this morning with plans to pull them back if winds got above 45 mph. This happened around 10:30 - sooner than expected. We are now getting reports of tornadoes touching down in western Louisiana. One of the New Orleans levees which had been patched has started to leak heavily with the water level already up 4 feet higher than normal - also sooner than expected. First picture attached I took while standing on this levee two days ago.

The second picture is from the New York Times only a few hours ago, and shows the leaking that is now happening.

The pre-stages FEMA response for Hurricane Rita is extensive. For Urban Search and Rescue (US&R), there are 14 teams (80 people each) and an Incident Support Team (IST) staged in Dallas and San Antonio. For Louisiana, they are adding three additional teams to the five we already have here in New Orleans in preparation for search and rescue activities in western Louisiana.

For Hurricane Katrina, US&R teams have conducted >6,500 rescues. US&R medical personnel have had over 4,000 patient contacts.

More when I can.

Hernando

9/25/05
Fortunately, the damage from Hurricane Rita was not as bad as it could have been. It seems that Texas had little enough damage that federal US&R resources will not be needed in significant quantities. Most of the worst damage happened in Southwestern Louisiana. We have done a quick evaluation of that area, and now have three teams in the Lake Charles area.

In the meantime, the New Orleans operations resumed yesterday as soon as the worst parts of the storm passed. What was once dry is now under 2-5 feet of water, so teams are once again continuing their searching in more difficult conditions. The good news is that we only have a little left to complete all operations in New Orleans. I will be heading home tomorrow.

Thank you for all of your support and help during this time. This effort is truly a group effort by many more than just the rescue personnel that are here working.

Hernando

hernando.garzon@kp.org