AAOS Bulletin - October, 2005

Hurricane Katrina devastates Gulf Coast

By Mary Ann Porucznik

For eight days in August—from Aug. 23-31—Hurricane Katrina raged over the Bahamas and southern United States. Alabama, Florida, Louisiana (especially New Orleans) and Mississippi were among the areas hardest hit.

In Mississippi, a storm surge with waves more than 25 feet high swept across the shoreline, demolishing everything in its path. In New Orleans, it wasn’t the storm as much as the aftermath that created problems. When the levee system on the Lake Pontchartrain side of the city gave way, heavy flooding covered almost the entire city, forcing the total evacuation of more than a million people and leaving most of the city uninhabitable.

In New Orleans, flooding swamped more than 80 percent of the city including the Louisiana State University Health care services hospital pictured here.

Federal disaster declarations covered 90,000 square miles. The hurricane left an estimated 5 million people without power, and hundreds of thousands without homes. News reports showed images of thousands languishing in the Louisiana Superdome and Morial Convention Center after the storm. Entire towns along the Gulf Coast disappeared, and the final death toll is yet to be calculated.

AAOS fellows, candidate members and residents were among those affected by the storm. As the waters finally receded and they were able to return to what was left, several shared their stories.

Ocean Springs, Miss.

AAOS fellow Alexander Blevens, MD, of Bienville Orthopaedic Specialists, LLC, in Ocean Springs, Miss., was one of the fortunate ones. He and his family evacuated to Montgomery, Alabama, during the storm and returned two days later to find that their home had sustained minimal damage.

Photos courtesy of Steven S. Greenberg, MD

(Top) A typical FEMA DMAT set-up. This was one of the first to open along the Gulf Coast after Katrina. It was operated by the NC-1 DMAT team, which saw 150 to 200 patients each day until the local hospital was ready to open.

“More than half of my partners have either completely lost their homes or are unable to live in them until they can be repaired,” he said. “Three of my partners have only slabs and pilings remaining.” In addition, nearly 20 percent of the staff at Bienville Orthopaedic Specialists lost everything.

One of those destroyed homes belonged to John K. Drake, MD. He had evacuated his family, but stayed behind because he was on call that weekend. When Katrina struck, Dr. Drake was at the hospital caring for a gunshot victim. He stayed at the hospital to treat patients injured in the maelstrom. With no electricity to power the hospital’s air conditioning system, temperatures in the operating room approached 95 degrees. But being in the hospital saved his life.

“It’s hard to imagine the usually tranquil Gulf of Mexico rising 30 feet and sweeping away, with crashing waves, 90 percent of all the structures on the coastline for almost 100 miles,” said Dr. Blevens. “Nothing was spared—high rise buildings crumbled, barges the size of football fields were washed across the road, highway bridge sections fell like dominoes, and homes were splintered into individual boards and sent crashing through neighboring houses. I have personally spoken to several people who actually swam from their homes to safety during the storm. Many families who lost their homes and jobs have already left the area.” Among them were several of Bienville’s staff. “We expect that it will take months for our practices to return to normal,” said Dr. Blevens.

The most difficult aspect of practicing orthopaedics after the storm was the lack of phone service. Land lines and cell towers were torn apart, knocking out vital lines of communication for days.

Photos courtesy of Alexander Blevens, MD

Katrina destroyed the home of AAOS member John K. Drake, MD. Dr. Drake’s family evacuated before the storm hit; he was on-call and stayed at the hospital. At least 11 of 33 AAOS fellows who lived on the Gulf Coast lost their homes.

“Communicating with your colleagues and the hospital was nearly impossible,” reported Dr. Blevens. “Responding to the emergency room, requesting consultations or obtaining test results were difficult and time-consuming. At one point when I left the hospital, I just gave the emergency room clerk my home address and asked her to send someone to knock on my door if they needed me.”

But things began to improve with the resumption of phone service and the initiation of rescue/recovery efforts.

“The national emergency response in this area of Mississippi has been truly amazing,” said Dr. Blevens. “The National Guard and the American Red Cross are very visible and helpful. Volunteer and Disaster Medical Assistance Team (DMAT) physicians have staffed triage and fast-track clinics all over the Coast.

“Patients with minor orthopaedic injuries were shipped by ambulance to the two remaining hospitals that had surgical capabilities. Severe injuries were evacuated by helicopter to other cities in the Southeast. The Mississippi Hospital Association set up a hotline to facilitate patient transfers. I had one patient with a spinal fracture who needed stabilization. I made one phone call to the hotline and spoke to a nurse who arranged transfer by helicopter immediately.

“The magnitude of this disaster has brought out the best in people,” said Dr. Blevens, “in both those who call South Mississippi their home and in folks from all around the country. Neighbors help neighbors—sharing homes, cars, meals, clothes; ripping out soggy carpets and drywall together. And then there are the spontaneous acts of generosity that are not organized through a relief group, like the store owner in Indiana who diverted a truckload of clothes, food and water to the area. So many ordinary people just want to help. Churches of all sizes and denominations have opened their doors to the homeless. It is truly amazing to see the American spirit alive and well in the aftermath of such a devastating storm.”

Gulf Port, Miss.

Steven S. Greenberg, MD, is an orthopaedic surgeon in Tamarac, Fla., and an active member of a Federal Emergency Management Agency (FEMA) DMAT team (FL-2). When Katrina struck, he answered the call for help.

“My DMAT team was deployed right after the storm, but I was held in reserve as a potential replacement in case we were needed a week or two down the line,” said Dr. Greenberg. “But then I got a call from Dr. John Halpern, the emergency room (ER) director at my local hospital, who had been deployed by FEMA to Gulf Port. He said there was a partially working hospital there that had no orthopaedic coverage.

“I arrived there on Sunday, Sept. 4. The hospital was running pretty well. There was power and running water in almost all areas, but hot water was limited and all the water was suspected of being potentially contaminated,” he said. Doctors and nurses used bottled water for everything, from cleaning wounds to washing hands.

“During the first two days, I treated mainly ER injuries—fractured wrists, elbows, hand injuries, a forefoot dislocation,” said Dr. Greenberg. Some cases were transferred to other hospitals out of the area to ensure they received adequate follow-up care.

On the third day, he was joined by John F. Irving, MD, an AAOS fellow who had come down from Connecticut with a group of doctors to help.

“We had operating room availability for emergencies and I did one trauma surgery, a guy with bilateral femur fractures from a large tree falling on him. The case went very well, but I don’t have any further information about his postoperative course,” Dr. Greenberg recalled.

By the fifth day one of the local orthopaedic surgeons had returned and was available to work. At this point Dr. Greenberg felt there was adequate coverage and made plans to return to Florida.

“Everybody—staff and patients alike—thanked all of us repeatedly. Despite the negative coverage from the national media, what I saw was good American people helping each other and really stepping up to the plate,” said Dr. Greenberg.

The U.S. military presence was a big help, according to Dr. Greenberg. They moved patients and delivered food, water and ice with big helicopters continuously during his stay in Gulf Port. The FL-1 FEMA DMAT set up a mobile unit nearby and the Air Force was setting up a full field hospital for longer term care.

New Orleans

AAOS fellows William G. DeLong Jr., MD, and Jeffrey O. Anglen, MD, were among those who went to New Orleans after the storm. Both were deployed with the International Medical and Surgical Response Team (IMSuRT) to the scene of the disaster. Dr. DeLong was assigned to the New Orleans airport and Dr. Anglen to West Jefferson Hospital on the west bank of the Mississippi River. Also serving at West Jefferson was Albert J. Aboulafia, MD, who had been called up as part of the Maryland Militia.

There, physicians saw more than 1,500 patients a day, mostly for immunizations, but also for a wide gamut of medical problems and injuries. West Jefferson was one of only four functioning hospitals left in New Orleans after the storm, and it was only partially active.

“We ended up providing all the medical care for this population, treating lots of chronic illnesses as well as things like chainsaw injuries, heat exhaustion, infections, bites, rashes, whatever,” said Dr. Anglen. “We also cared for the military and police working in the city, and each other; there were volunteers and DMAT teams from all over the country—New York, Minnesota, Alaska, California, to name a few.”

“We were assigned to establish a triage center for people who were evacuating the area,” said Dr. Aboulafia. “The hospital administrator set up a pharmacy operation across the street from the hospital so that people could get needed medications such as insulin or warfarin. The National Guard provided protection.”

Orthopaedic department offices at Louisiana State University in New Orleans moved to Lafayette, La., so that residents like Roger H. “Field” Ogden, MD, could continue their clinic schedules uninterrupted. All faculty and residents made it safely out of the city. Rotation assignments were adjusted to take into account the needs of residents and faculty. However, according to Barry L. Riemer, MD, program chairman, most of the residents and staff lost teaching and learning materials, such as desk and laptop computers, textbooks and video projectors.

“Many of our residents have lost everything,” said Dr. Riemer, “and their families and extended families have lost everything. But the spirit of this group is inspiring. We will stay together and emerge stronger than ever. New Orleans will rebuild and we will continue training excellent orthopaedic surgeons in the Big Easy.”

When Dr. Riemer checked into the AAOS private discussion group/chat room on Katrina, he wrote:

“We have true heroes among us. Our colleagues worked quietly in many of the areas that were shown on television, helping people with no hope. Our colleagues diverted resources from other cities to resupply damaged hospitals. And this is just the tip of the iceberg. The outpouring of support has been stunning. I have never been more proud to be a part of the orthopaedic community.”

The AAOS quickly responded to Dr. Riemer’s request for learning materials. Jeffrey Kramer, director of academic affairs, helped coordinate efforts regarding residents. Books, videos and CDs were shipped gratis to the LSU residency program.

“Thank God for the Academy,” said Linda Miller, residency coordinator for the Tulane University orthopaedic program. “Their help was invaluable in ensuring that everyone was placed in a new program on a timely basis.”

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