Clinical Notebook/Journal of Emergency Medicine/February 2006

            We were members of DMAT (Disaster Medical Assistance Team) Missouri-1 deployed on August 28, 2005, to assist in the aftermath of Katrina. Our destination was Bay St. Louis and as we traveled south, the devastation become more and more severe; the eye of the hurricane had passed through the Bay St. Louis, Waveland and Gulfport areas.

            Setting up base camp on the grounds of the Hancock Medical Center, the hospital serving Bay St. Louis and surrounding communities, we were met by the staff. Hancock, located one half mile from the bay, was hit by a 30-foot wave surge that traveled 10 miles inland, wreaking havoc both coming in and on egress. All utilities were knocked out and the area was under mandatory nightly curfew from 6 p.m. until 7 a.m.

            Patients began arriving before we finished setting up our freestanding emergency care area of two large tents and a covered triage area.  On our first day, we treated more than 450 patients. Within days, we were joined by DMAT Florida-1, followed by DMATs Iowa-1, Connecticut-1, and Pennsylvania-1.  Together, we treated over 4,500 patients during the 15 days we were deployed.

            The Hancock staff had been working without electricity (except for limited emergency power), water, air conditioning, or functional toilets since the hurricane. Prior to Katrina’s landfall, the staff evacuated most of their patients, but stayed with the ones who could not be discharged or transported. The staff carried these patients to the upper floors to escape flooding; afterward, the hospital had 5 feet of water in the ground level and snakes, probably water moccasins, were seen in surgery, obstetrics and radiology.

            As emergency care providers, we saw patients with the same illnesses and injuries that any emergency department sees, ranging from critical to minor. Our patients had strokes, heart attacks, traumatic injuries, diabetic emergencies, and mental health emergencies. A big part of our work included providing a clean, dry, safe place for people to come and “just talk.”

            The emotional stress for the patients we treated was evident. Many were camping in their vehicles while others were literally sleeping on the ground of their destroyed homes. Although the town was “wiped out,” we consistently heard the same message from patients, “We made it through Ivan and Camille, and Katrina isn’t going to run us out.”

            Initially, the nearest functioning hospital was 3 hours away. Critical patients were transported by Coast Guard helicopter owing to inaccessibility of the roads. As the days progressed, more hospitals became functional and patients could be transported by ground ambulance to destinations approximately 40 to 60 minutes away. During the second week, we were joined by the National Guard and Homeland Security Police, both welcome and appreciated sights.

            Bay St. Louis, Mississippi, was “Ground Zero” for Hurricane Katrina and words cannot describe the destruction and remnants of shattered lives we witnessed. Many people were unaccounted for. Families came to our compound searching for clues and hoping their loved ones might have crossed our paths. One family stayed in their home when Hurricane Katrina made landfall. The father, his son, and two daughters fled when their house started to collapse. The grandmother stayed, and perished.

            As thousands of relief workers arrived, the water supply was still unsafe and health conditions remained hazardous. Most of Mississippi’s 466 water systems were impacted by Katrina. The environmental Protection Agency (EPA) deployed 12 Environmental Emergency Response Teams to begin initial environmental assessments. The EPA also reported that a damaged oil terminal along the state line between Alabama and Mississippi was leaking into surrounding water, further jeopardizing the water supply.

            Upon deployment, we were advised that our primary focus was communicable disease outbreaks, which occur when sanitation and hygiene are compromised. We knew many people would not have access to clean water, disinfecting agents, vaccinations, and health care. We knew many residents would be unable to limit contact with floodwater and could potentially be exposed to waterborne illnesses spread by swallowing, breathing, or having contact with contaminated water.

            We knew rivers, lakes, and oceans could be contaminated by animal waster, sewage, refinery spills, and water run off. Any one of these conditions could contribute to the waterborne illness we saw and treated as people waded through contaminated water to collect their personal items following the storm.

            Additionally, we knew floodwater often contains fecal material from overflowing sewage systems and agricultural and industrial byproducts. While skin contact with floodwater does not by itself pose a serious health care threat, ingesting anything contaminated with floodwater can cause illness and disease. We saw this in the days following Katrina when many people were treated for diarrhea apparently contacted from contaminated canned goods that were not thoroughly washed before opening.

            We treated several infants with diarrhea. Luckily, we were able to orally rehydrate most of them, although a few were also placed on antimicrobials. Specific patient treatment was based on the health care provider’s clinical judgment. We used oral rehydrant solutions when patients were able to consume the required volume, otherwise intravenous fluids were administered. The decision to treat with antimicrobial therapy was made on a patient-by-patient basis.

            Patient education was one of our priorities and included safety and preventative measures related to the environment. As medical providers, we take many of these instructions for granted (such as thorough, frequent hand washing), but our patients found them very valuable.

            Initially, we had no copier, so we gave verbal instructions in answer to questions form our patients. For instance, when asked how to deal with the loss of electricity, we advised treating all cables and wires as if they were “hot,” as well as turning off or unplugging appliances so systems would not overloaded when power was restored.

            The temperature and humidity were both very high; the heat index when we arrived was 115 degrees F. Keeping cool was a priority for patients as well as staff. We had several of our Logistics Team members who became dehydrated and had to be given 3,000 ccs of lactated ringers for fluid replacement.  We instructed all staff and patients to wear loose, light-colored clothing and a hat.

            Water issues included disinfecting tap water by either boiling, using liquid chlorine, or iodine. We advised people not to drink from wells or pools, we suggested giving bottled water to pets, and we encouraged people to wash their hands frequently and thoroughly.

            One bacterial disease identified among Hurricane Katrina victims was Vibrio vulnificus, which causes infection in open wounds exposed to warm sea water. The elderly and those with weakened immune systems were at greatest risk. Normally, this bacterium is a rare cause of illness in the United States, and the infection does not spread directly from person to person. In all, 18 cases of post-Katrina Vibrio illness were identified in Mississippi and Louisiana, with five patients dying from wound-associated Vibrio infections in the days to come.

            We also treated various other skin infections caused by bacteria from exposure to floodwaters, as well as numerous insect bites. We cautioned both the public and emergency response personnel to eliminated, or reduce as much as possible, contact with floodwater. We advised routine washing with soap and clean water, not eating or drinking while in contact with floodwater, and seeking medical care immediately if experiencing any signs or symptoms of a water-borne illness.

            We fell blessed to have served with our DMAT team in Mississippi. The strength and perseverance of the many people who fought Katrina were truly incredible. The opportunity to help those in need at a time when our county was struck by the most devastating hurricane in history was truly life changing.

-          Joan Eberhardt, RN, BSN, MA, CCRN, FAEN

      administrative director, trauma services & emergency management