A Doctor's Message from Katrina's Front Lines
September 7, 2005 · Hemant Vankawala, 34, is a doctor with one of the nine Disaster Medical Assistance Team (DMAT) medical groups set up at Louis Armstrong New Orleans International Airport, treating evacuees from New Orleans. He is an emergency room physician in Dallas, Texas, and joined a Dallas-based DMAT just two months ago -- just in time for the biggest natural disaster in American history.
Here are excerpts from an e-mail he sent to family, friends and colleagues about his experience:
My team was activated 11 days ago. For the past eight days, I have been living and working at the New Orleans airport, delivering medical care to the Katrina hurricane survivors.
Let me start by saying that I am safe, and after a very rough first week [I] am now better-rested and fed. Our team was the first to arrive at the airport and set up our field hospital. We watched our population grow from 30 DMAT personnel taking care of six patients and two security guards [to] around 10,000 people in the first 15 hours.
These people had had no food or water or security for several days and were tired, frustrated, sick, wet, and heartbroken. People were brought in by trucks, buses, ambulances, school buses, cars and helicopters. We received patients from hospitals, schools, homes ... the entire remaining population of New Orleans, funneled through our doors.
Our little civilian team, along with a couple of other DMAT teams, set up and ran the biggest evacuation this country has ever seen. The numbers are absolutely staggering.
In hindsight, it seems silly that a bunch of civilian yahoos came in and took over the airport and had it up and running -- exceeding its normal operating load of passengers -- with an untrained skeleton crew and generator partial power. But we did what we had to do, and I think we did it well.
Our team has been working the flight line, off-loading helos [helicopters]. Overnight, we turned New Orleans' airport into the busiest helicopter base in the entire world. At any given time, there were at least eight to 10 helos off-loading on the tarmac, each filled with 10 to 40 survivors at a time, with 10 circling to land ... It was a non-stop, never-ending, 24-hour-a-day operation.
The CNN footage does not even begin to do it justice -- the roar of rotor blades, the smell of jet-A [fuel] and the thousands of eyes looking at us for answers, for hope...
Our busiest day, we off-loaded just under 15,000 patients by air and ground. At that time, we had about 30 medical providers and 100 ancillary staff. All we could do was provide the barest amount of comfort care. We watched many, many people die. We practiced medical triage at its most basic -- "black-tagging" the sickest people and culling them from the masses so that they could die in a separate area.
I cannot even begin to describe the transformation in my own sensibilities, from my normal practice of medicine to the reality of the operation here. We were so short on wheelchairs and litters we had to stack patients in airport chairs and lay them on the floor. They remained there for hours, too tired to be frightened, too weak to care about their urine- and stool-soaked clothing, too desperate to even ask what was going to happen next.
Imagine trading single-patient-use latex gloves for a pair of thick leather work gloves that never came off your hands -- then you can begin to imagine what it was like.
We did not practice medicine. There was nothing sexy or glamorous or routine about what we did. We moved hundreds of patients an hour, thousands of patients a day, off the flightline and into the terminal and baggage area. Patients were loaded onto baggage carts and trucked to the baggage area ... like, well, baggage. And there was no time to talk, no time to cry, no time to think, because they kept on coming. Our only salvation was when the bureaucratic Washington machine was able to ramp up and streamline the exodus of patients out of here.
Our team worked a couple of shifts in the medical tent as well. Imagine people so desperate, so sick, so like the five to 10 "true" emergencies you may get on a shift ... only coming through the door non-stop. Now imagine having no beds, no [oxygen], no nothing -- except some nitro, aspirin and all the good intentions in the world.
We did everything from delivering babies to simply providing morphine and a blanket to septic and critical patients, and allowing them to die.
During the days that it took for that exodus to occur, we filled the airport to its bursting point. There was a time when there were 16,000 angry, tired, frustrated people here. There were stabbings, rapes and people on the verge of mobbing. The flightline, lined with two parallel rows of Dauphins, Sea Kings, Hueys, Chinooks and every other kind of helicopter imaginable, was a dangerous place -- but we were much more frightened whenever we entered the sea of displaced humanity that had filled every nook and cranny of the airport.
[It's] only now that the thousands of survivors have been evacuated -- and the floors soaked in bleach, the putrid air allowed to exchange for fresh, the number of soldiers [outnumbering] the patients -- that we feel safe.
I have met so many people while down here -- people who were at Ground Zero at 9-11, people who have done tsunami relief, tours in Iraq -- and every one of them has said this is the worst thing they have ever seen. It's unanimous, and these are some battle-worn veterans of every kind of disaster you can imagine.
For those of you who want to help, the next step is to help [evacuees] who arrive in your local area. The only real medical care these survivors will receive is once they land in a safe, clean area far from here. For the 50,000 people we ran through this airport over the last couple of days -- if they were able to survive and make it somewhere else -- their care will begin only when providers in Dallas and Houston and Chicago and Baton Rouge volunteer at the shelters and provide care.
And yes, there are many, many more on their way. Many of the sickest simply died while here at the airport. Many have been stressed beyond measure and will die shortly, even though they were evacuated. If you are not medical, then go the shelters, hold hands, give hugs and prayers. If nothing else, it will remind you how much you have, and how grateful we all should be.
These people have nothing. Not only have they lost their material possessions and homes, many have lost their children, spouses, parents, arms, legs, vision... everything that is important.
Talk to these survivors, hear their stories and what they have been through. Look into their eyes. You will never think of America the same way. You will never look at your family the same way. You will never look at your home the same way. And I promise, it will forever change the way you practice medicine.
Hemant H. Vankawala, M.D.
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The perspective of repair crews:
Power crews diverted
Restoring pipeline came first
By Nikki Davis Maute
RANDY SNYDER | Hattiesburg American
Shortly after Hurricane Katrina roared through South Mississippi knocking out electricity and communication systems, the White House ordered power restored to a pipeline that sends fuel to the Northeast.
That order - to restart two power substations in Collins that serve Colonial Pipeline Co. - delayed efforts by at least 24 hours to restore power to two rural hospitals and a number of water systems in the Pine Belt.
At the time, gasoline was in short supply across the country because of Katrina. Prices increased dramatically and lines formed at pumps across the South.
"I considered it a presidential directive to get those pipelines operating," said Jim Compton, general manager of the South Mississippi Electric Power Association - which distributes power that rural electric cooperatives sell to consumers and businesses.
"I reluctantly agreed to pull half our transmission line crews off other projects and made getting the transmission lines to the Collins substations a priority," Compton said. "Our people were told to work until it was done.
"They did it in 16 hours, and I consider the effort unprecedented."
Katrina slammed into South Mississippi and Southeast Louisiana on Aug. 29, causing widespread devastation and plunging most of the area - including regional medical centers and rural hospitals - into darkness.
The storm also knocked out two power substations in Collins, just north of Hattiesburg. The substations were crucial to Atlanta-based Colonial Pipeline, which moves gasoline and diesel fuel from Texas, through Louisiana and Mississippi and up to the Northeast.
"We were led to believe a national emergency was created when the pipelines were shut down," Compton said.
White House call
Dan Jordan, manager of Southern Pines Electric Power Association, said Vice President Dick Cheney's office called and left voice mails twice shortly after the storm struck, saying the Collins substations needed power restored immediately.
Jordan dated the first call the night of Aug. 30 and the second call the morning of Aug. 31. Southern Pines supplies electricity to the substation that powers the Colonial pipeline.
Mississippi Public Service Commissioner Mike Callahan said the U.S. Department of Energy called him on Aug. 31. Callahan said department officials said opening the fuel line was a national priority.
Cheney's office referred calls about the pipeline to the Department of Homeland Security. Calls there were referred to Kirk Whitworth, who would not take a telephone message and required questions in the form of an e-mail.
Susan Castiglione, senior manager of corporate and public affairs with Colonial Pipeline, did not return phone calls.
Compton said workers who were trying to restore substations that power two rural hospitals - Stone County Hospital in Wiggins and George County Hospital in Lucedale - worked instead on the Colonial Pipeline project.
The move caused power to be restored at least 24 hours later than planned.
Mindy Osborn, emergency room coordinator at Stone County Hospital, said the power was not restored until six days after the storm on Sept. 4. She didn't have the number of patients who were hospitalized during the week after the storm.
"Oh, yes, 24 hours earlier would have been a help," Osborn said.
Compton said workers who were trying to restore power to some rural water systems also were taken off their jobs and placed on the Colonial Pipeline project. Compton did not name specific water systems affected.
Callahan's visit
Callahan is one of three elected public service commissioners who oversee most public utilities in the state. Commissioners, however, have no authority over rural electric power cooperatives.
Nevertheless, Callahan said he drove to Compton's office on U.S. 49 North in Hattiesburg to tell him about the call from the Department of Energy. Callahan said he would support whatever decision Compton made.
Callahan said energy officials told him gasoline and diesel fuel needed to flow through the pipeline to avert a national crisis from the inability to meet fuel needs in the Northeast.
Callahan said the process of getting the pipelines flowing would be difficult and that there was a chance the voltage required to do so would knock out the system - including power to Wesley Medical Center in Hattiesburg.
With Forrest General Hospital operating on generators, Wesley was the only hospital operating with full electric power in the Pine Belt in the days following Katrina.
"Our concern was that if Wesley went down, it would be a national crisis for Mississippi," Callahan said. "We knew it would take three to four days to get Forrest General Hospital's power restored and we did not want to lose Wesley."
Compton, though, followed the White House's directive.
Nathan Brown, manager of power supply for the electric association, was responsible for overseeing the delicate operation of starting the 5,000-horsepower pumps at the pipeline.
Engineers with Southern Co., the parent company of Mississippi Power Co., did a dual analysis of what it would take to restore power and Brown worked with Southern Co. engineers on the best and quickest way to restore power.
Work began at 10 a.m. Sept. 1 and power was restored at 2 a.m. Sept. 2 - a 16-hour job.
Night work
A good bit of the work took place at night.
Line foreman Matt Ready was in charge of one of the teams that worked to power the substations and the pipeline. Ready's shift started at 6 a.m. Sept. 1; he received word about the job four hours later and saw it to completion.
"We were told to stay with it until we got power restored," Ready said. "We had real safety issues because there were fires in the trees on the lines and broken power poles."
Ready described working on the lines in the dark like attempting to clear fallen trees out of a yard with a flashlight and a chain saw.
"Everything was dangerous," he said.
Ready said the crew members did not learn they were restoring power to pipelines until after the job was done.
How did they feel about that?
"Is this on the record?" Ready asked. "Well, then, we are all glad we were able to help out."
Compton said he was happy to support the national effort. But he said it was a difficult decision to make because of the potential impact in the region had the plan not worked and the area's power restoration was set back days.
"It was my decision to balance what was most important to people in South Mississippi with this all-of-a-sudden national crisis of not enough gas or diesel fuel," Compton said.
"In the future, the federal government needs to give us guidelines if this is such a national emergency so that I can work that in my plans."
Originally published September 11, 2005