Member Testimonials

Anesthesiologist from California tells of chaos and challenges in responding to Hurricane Katrina

Thomas H. Cromwell, M.D., an anesthesiologist at California Pacific Medical Center in San Francisco, is a member of a Disaster Medical Assistance Team (DMAT CA 6), which is one of a series of voluntary medical teams around the country under the National Disaster Medical System (NDMS), which is in turn under the Federal Emergency Management Agency (FEMA). The following report is taken from a letter that Dr. Cromwell sent to his medical group on September 5, 2005.

I returned from New Orleans late last night, and I apologize for leaving you all in a lurch on such short notice a week ago. Let me explain ¼ Our group, which consisted of two doctors, four nurses, eight paramedics and 15 support personnel, was activated last Sunday [August 28] at 1 p.m. with orders to report to our warehouse in Menlo Park for immediate departure to assist in the hurricane should we be needed. This was the day before the hurricane struck New Orleans, and consequences were as yet unknown. This is the first time FEMA has activated the entire DMAT system. Many months ago, I had discussed just such an eventual deployment with Ed and Steve Lockhart and Steve’s possible availability to cover me if I was deployed on an urgent basis. Sunday morning I was unable to contact Steve, so I e-mailed Lisa about coverage, and she indicated we could cover my absence. I could have refused to accompany the team, but they are unable to deploy unless they have two physicians.

Our team was flown from San Jose Sunday evening to stage in Houston along with five or six other teams. We held briefings throughout the day Monday to assess the damage as the hurricane passed. On Tuesday morning, we were advanced to the Louisiana State University campus at Baton Rouge and assisted in setting up a small treatment center on the floor of the basketball arena. Incoming students had been advised to delay opening of classes for one week. The New Mexico DMAT team was sent to the Superdome (SD) early Tuesday morning as it became apparent that it would be used as the collection point for those unable or unwilling to leave New Orleans. They set up their treatment facility on the floor of the ice arena adjacent to the SD but had to move it to the concourse level when the arena floor flooded as a result of the levee rupture. As thousands of people converged on the SD throughout Tuesday, the team needed assistance, and we were ordered to replace them. We arrived by a police-escorted convoy Tuesday afternoon and were met by literally thousands of people milling around on the SD ramps attempting to make their way in, many wading through now waist-deep water. We drove into the ice rink, which was now pitch black due to loss of power and stifling in the 100-degree heat without air conditioning. Words cannot describe the scene we encountered as we made our way up to the concourse level, congested with hundreds of people waiting for treatment. There was no running water, toilets were overflowing but were continued to be used in desperation.

I met with an emergency room physician from the New Mexico team and had a 10-minute reorientation to primary care medicine, and their team then left. We worked through the night doing what we could for an assortment of severe dehydration, chest pain, acute asthma, hyper- and hypoglycemia, assorted trauma, including GSW’s, active labor (delivered one baby), CVA, psychotic breaks, renal failure, etc. You name it, we saw it as patients collapsed in the SD and were dragged over to us. We attempted to helicopter the unstable patients out, but the helicopters quit running at about 9 p.m. when they were being fired upon. Unable to transport by ambulance due to the flooding, we were unable to get any critical patients out, and they continued to build up. The pace was so frantic that we had no time to even attempt to clean the place, and there was no water to wash gurneys between patients. Throughout the night, more and more refugees converged upon the SD, which became increasingly chaotic, and the few national guard troops there were unable to maintain control. The next morning, fires were being started in the SD along with shootings, rape and who knows what all. By 9 a.m. it became apparent that we had no protection, and the order was passed that we would have to evacuate the area. We were forced to literally abandon the patients, many of whom had I.V.s running, etc. We exited down onto the floor of the ice rink, boarded our three trucks and made our way up the ramps through swelling crowds in the most harrowing ride of my life.

We drove back to Baton Rouge to find the treatment center on the basketball floor had become a 200-bed hospital for acute patients, and our DMAT took over the field house, which was designated as the step-down facility. On Friday the New Orleans airport, which had become the receiving center for an estimated 3000 people from the SD and Convention Center, had swelled to 7,000 patients so most of our team was sent there. I remained in Baton rouge with four other team members to assist in setting up the morgue facility that will now attempt to identify bodies as they are uncovered when the water level drops. They are now estimated at 10,000.

Several people have asked me what services an anesthesiologist can provide in such a situation as we are so highly specialized and deal infrequently, if ever, in primary care. The skills we utilized in the Superdome are skills that can be provided by any doctor, regardless of specialty. As the first wave of response, our goal was to treat as many patients as quickly as possible to extend their survival 24-36 hours until they could be evacuated for more definitive care. In that regard, we were quite successful despite the austere conditions, and I am confident that 200-300 patients survived as the result of the efforts of DMAT CA 6.