The amphibious assault ship USS Iwo Jima makes its way into port following relief and recovery efforts as part of Joint Task Force Katrina. U.S. Navy photo by Photographer's Mate 3rd Class Christian Knoell.

n August 29, 2005, as the entire nation watched and waited, Hurricane Katrina made its second landfall along the central Gulf Coast of the United States. Though this now infamous storm had weakened significantly from its peak as a category 5 storm, it still caused widespread damage and devastation along the coasts of Alabama, Mississippi and Louisiana. It was the one of the costliest and most destructive hurricanes ever to hit the United States, leaving in its wake more than 1,300 dead, 4,000 missing and approximately $75 billion in damage.

In addition to the numerous national and international organizations that sent teams to provide assistance to this devastated region, the United States military also quickly mobilized troops to respond in numerous capacities. As part of this relief effort, a Casualty Receiving Trauma Ship (CRTS) team from the Naval Hospital in Portsmouth, Virginia, was assembled in order to augment medical support in Louisiana. This team was made up of a varied and highly specialized group of medical personnel, including general and orthopedic surgeons, gynecologists, numerous primary care and emergency physicians, psychiatric specialists, nursing staff and ancillary personnel. The anesthesia team consisted of an anesthesiologist and two nurse anesthetists.

Though reaching the most affected areas with medical personnel and supplies proved to be somewhat challenging, the team joined the USS Iwo Jima, which had successfully maneuvered the tenuous navigation channels of the Mississippi River and was docked pier-side in downtown New Orleans. The USS Iwo Jima, a multipurpose amphibious assault ship whose primary mission is to transport troops by sea and air, served as one of the primary command centers and medical facilities during the Katrina aftermath. The USS Iwo Jima is equipped with both modern medical and dental facilities and features an intensive care unit, an inpatient ward and up to six operating rooms as well as limited radiology, blood bank and laboratory capabilities.

Multifaceted Mission
Our mission proved to be multifaceted; during the initial period following Katrina, a significant portion of New Orleans’ population remained in the city. In conjunction with some of the city’s medical centers that still had functional capabilities, we became a surrogate trauma center. Due to our proximity to the city’s center and our transportation and medical capabilities, we provided initial emergency care and stabilization of life-threatening injuries.

This mission began shortly after embarking, when a New Orleans resident who had sustained a stab wound to the chest was transported to the ship. After initial emergency assessment and airway management, he was taken to the operating room for wound exploration and removal of the knife, which was still lodged in his left anterior chest wall. His injury fortunately proved to be non-life-threatening. The knife had in fact entered his pleural cavity but had not damaged any organs or major blood vessels. After an extensive wound washout and chest tube placement, he was extubated and taken to the combined intensive care unit/postanesthesia care unit for observation where he had an uneventful postoperative course and was subsequently transferred to a nearby medical facility for continued care.

In addition to providing care to citizens of this affected area, we soon became the primary treatment facility for the 75,000-plus troops now present in the region. Most of these troops were performing hard labor in extreme heat and humidity. Orthopedic injuries became a common occurrence due to the heavy lifting and transporting of supplies that was essential during this period of time. Open reductions and external fixations became almost a daily routine, though we had a broad variety of cases, including a ruptured ectopic pregnancy in a young woman who had suffered significant blood loss as a result. There also were some additional civilian and military trauma patients to cross our doors. With helicopters and military transport vehicles as the primary forms of transportation due to flooding and storm debris, we received both helicopter and motor vehicle crash victims. Fortunately all helicopter passengers sustained only minor injuries after one of the helicopter rotors failed and caused the aircraft to crash onto a rooftop. Not all accidents were so benign. A young serviceman riding in the back of a Humvee was not so fortunate. He was ejected from the vehicle after it was struck by another vehicle at an intersection. Nearby medical personnel quickly secured him on a backboard with cervical spine precautions and transported him to the Iwo Jima. Upon reaching the emergency triage area, he was noted to have a GCS of 6 and a possible widened mediastinum. After securing his airway with in-line stabilization, he was airlifted to a trauma center for more definitive care due to our lack of CT scanning and neurosurgical capabilities.

One of the first cases that Dr. Krakusin saw on the Iwo Jima was a man who had been transported to the ship with a knife wound to his chest. Although the victim had sustained injuries to his pleural cavity, they were not life-threatening, and he was soon transferred to a nearby facility on land. Photos by John Froio, M.D.

After spending nearly one month aboard the USS Iwo Jima, our team disembarked after having performed 26 surgical cases and providing emergency care to countless civilian and military patients. Though a ship cannot truly substitute for a freestanding tertiary care hospital, the Iwo Jima, with its extensive medical and surgical capabilities, served as a temporary hospital in a city whose medical resources were strained and overburdened in the aftermath of this natural disaster. While this was not the typical mission we train for, we were able to respond and in some small way provide assistance in the aftermath of this disaster.

Ana C. Krakusin, M.D., Lt. Cmdr. (sel.), Medical Corps, U.S. Navy Reserve, is a staff anesthesiologist at Naval Medical Center Portsmouth, Virginia.