With patients in dire straits, hospital needs help ‘in a hurry’

Three days after Lake Ponchartrain claimed New Orleans’ Charity Hospital, hundreds of doctors and patients were still marooned Thursday in dangerous waters without food, water, medicine or power.

The phones were dead, the halls were dark and the heat unbearable. Desperately ill patients who needed oxygen were being kept alive by a rotation of health workers pumping air into their lungs using bladders called ambu-bags.

“Somebody needs to come in a hurry,” says Norman McSwain, director of trauma surgery at Charity. “By ‘in a hurry,’ I don’t mean tomorrow or the next day. They need to get here tonight.

“By tomorrow, we’ll have dead patients simply because they were not evacuated.”

Michael Leavitt, secretary of Health and Human Services (HHS), says the government is scrambling to come to the rescue, with the help of hospital firms and drug companies that have offered personnel and medical supplies. The resources are there, Leavitt says, but the flood has made it all but impossible to deliver them.

He expressed particular concern about the situation at Charity Hospital, as described by McSwain. “His comment breaks my heart,” Leavitt says. “There are tens of thousands of people doing their best to get there in a hurry.”

The aftermath of Hurricane Katrina poses the most dire threat to the oldest operating hospital in America, an aged, battered and storied institution founded in 1736 by a French sailor. It has long been the last resort for most of the city’s sickest and neediest people.

But never more so than now.

Since Tuesday, 650-bed Charity has been separated from its sister hospital across the street, Tulane University Medical Center, by a river of filthy water that rushed in from breached levees not far away.

The deluge knocked out the hospital’s power and telephones – and forced doctors to move the emergency room from the first to the second floor. Ever since the waters rose, doctors, nurses and health workers have gotten news out of the hospital only by wading, swimming or boating to Tulane across the waist-deep divide.

When Katrina hit, Tulane had 122 patients, Charity about 250. Tulane, with a rooftop heliport over its garage, was able to replenish some supplies and slowly evacuate its patients by helicopter.

Without such access to relief flights, Charity’s food and water have all but run out. “There’s no plumbing. They’re having to go to the restroom in plastic bags, tying them in a knot. We are brushing our teeth with IV fluids, because those are the only fluids we had,” says Kaira King, 29, a resident at Charity’s emergency room.

“It stinks so bad at Charity that residents are sleeping on the roof,” she says. “It’s wet. It’s hot. They’re taking mattresses to the roof and sleeping on them.”

Charity has been able to evacuate only a handful of its patients, ferrying them to Tulane by boat and then carrying them up to the heliport. Helicopter pilots and doctors reported another ominous development, gunshots fired at the hospital. Ruth Berggren, an infectious-disease specialist at Charity, told CNN her husband had been fired on by an armed man Thursday morning as he tried to evacuate a patient.

“They are shooting at the helicopters as they try to land at the hospitals. There are shooters outside boating around,” King says.

Tom Judge, president of the Association of Air Ambulance Services, the trade group whose members are transporting patients to hospitals outside of the flood area, complains of “massive disorganization” in the evacuation effort.

“Lots of people are willing to do stuff, but nobody knows who’s in charge here,” Judge says. He says desperate hospitals are making their own arrangements with private ambulance companies to transport patients and staff.

Judge expressed frustration at the level of federal involvement. “These informal (hospital) plans are delivering faster and more effectively than the federal plans, and we should do better than that.”

Activated crisis plans

Both hospitals took steps to prepare for the crisis. When word came that Hurricane Katrina was churning through the gulf toward New Orleans, both Charity and Tulane activated their crisis plans, calling in doctors, nurses, medical students and technicians who had volunteered to risk calamity in order to save lives.

Michael Catenacci, 31, an emergency doctor at Tulane and Charity, and King’s husband, said, “The storm hit on Sunday worse than anyone had imagined. We saw 150-mile-an-hour winds going past the doors. All the windows were smashed.”

Ironically, he said, Sunday and Monday were far better than what would follow. Catenacci and King worked at Charity’s emergency room Monday morning as the storm raged. By midmorning, the power went out.

“There was almost total darkness in the ER. The ventilators didn’t work, so the residents began taking turns ambu-bagging the patients,” he said. “We had no services at all. We couldn’t check (lab results), X-rays or CAT scans.”

In the middle of the storm, King says a patient turned up in the emergency room with serious gunshot wounds to the neck, face and abdomen. Charity’s operating room wasn’t functioning, so the patient was transferred to Louisiana State University Medical Center for surgery. McSwain says his colleagues did their best to patch the patient up but he was still critically ill Wednesday. His fate late Thursday was unknown.

CDC sending teams

“In a situation of this magnitude, the routine day-to-day medical care that people take for granted goes by the wayside,” says Corey Slovis, chairman of emergency medicine at Vanderbilt Medical Center in Nashville. Patients with special medical needs “might not get the care and may suffer irreparable harm or death.”

HHS Secretary Leavitt says the government is still trying to figure out the extent of the crisis and how best to respond. The Centers for Disease Control and Prevention has assembled two dozen 20-member teams ready to go into the gulf area and are “negotiating deployment of one or more of these teams,” said CDC director Julie Gerberding in a briefing Thursday.

“We have advance teams checking the situation and trying to help with assessment of what is needed,” she said. Teams include experts in infectious diseases, environmental health, mental health, experts in rape and injury, immunization and mosquito control.

Gerberding said 8,000 doses of tetanus vaccine are en route to Mississippi, and the agency will help staff 40 emergency medical shelters being set up in the region.

“This is the most tragic national disaster we’ve experienced,” she said.

‘Take care of the people’

A more immediate concern remains, says Georges Benjamin, executive director of the American Public Health Association. “I’m an emergency room doctor, and one of the things you learn from doing this kind of medicine is that when bad things occur, take your own pulse first, then solve the problem. There are priorities: Search and rescue, and take care of the people first.”

More than 200 patients and several hundred doctors, health workers and some families must still be evacuated from Tulane and Charity hospitals. Late Thursday afternoon, the U.S. Surgeon General’s office told the Associated Press that five private helicopters would soon start rescue flights to Charity.

Coast Guard Lt. Cmdr Jeff Carter told USA Today that the Federal Emergency Management Administration has asked the Coast Guard to assist in evacuations at New Orleans hospitals. “We’ll be doing rooftop extractions as soon as possible.” He added: “There are some areas where shots were fired. We are avoiding those until we get some assurance our crews can fly in there. As much as we want to help these people, the safety of our people has to be a concern.”