3 Days in Louisiana: A PA Reports

Thomas Lahut, PA, MS, usually works at St. Peter's Hospital Emergency Department, in Albany, NY. But for the last few days he has worked in Baton Rouge, LA, at the Temporary Medical Operations Staging Areas for the evacuees from New Orleans.

Monday, September 5, 2005: Some of the patients, seen at the Temporary Medical Operations Staging Area at the P-MAC in  Baton  Rouge    are described here. Most had reluctantly been evacuated from New Orleans now that martial law has been established by a growing 40-state National Guard contingent:

- 48 yo female, SOB, dehydrated, schizophrenic, no meds, ETOH 1hr PTA

- 21 yo male, hypothermic, in water for 3 hours attempting to get to a rescue boat for family with autistic member, succeeds, then struck by helicopter landing gear exiting with wind gust. Gash without fracture; now shaking with audible wheezes.

- 55 yo female, substernal chest pain, anxious, improves with psych liaison

- 64 yo male, prior TBI, BMI >40, Code Brown – rehydrated, sent for NH placement

- 42 yo male, uremic, no HD x 7 days, FSG 42, improves to 127mg/dl with Gatorade and sugar

- 55 yo female, BP 210/108 after EMS placed foley and IV Lasix 40mg; greatly improved with NTG and Lisinopril, pharmacy fills a week of meds to go.

- 36 yo female, ‘trench foot’ after punctures and multiple immersions for 3 days, IV Abx with return in AM planned.

- 45 yo male, IDDM, tarry feet & puncture, (no shoes); Rx insulin and Keflex

- 91 yo female, SDAT, HTN, never uses meds per daughter, now combative and mute; rehydrated after U/A and labs

It goes on. The patient/family interactions are a great source of satisfaction, as well as the wonderful professional contacts.

************************

Sunday, September 4, 2005: Deeply troubling to see the extent of devastation - the lives of people here, after the Hurricane Katrina. The stories of victims, as well as those stories of the extremely generous people here, are very moving.

Tragedy brings out extremes. But I cannot commend highly enough the churches, university, local police, and the whole of the community her, for opening up their lives to the difficulties in the New Orleans region.

The magnitude of the difficulties is analogous to an iceberg. Even hearing first hand of the problems, it is difficult to adequately place it all in context.

My work is just one element of the multiple needs here. Accounting of death has not been attempted. The survivors tell stories, but obviously the young and old, weak and frail were most vulnerable in the hurricane.

Enduring in the subsequent flooding, lack of water and electricity, and the mandatory exodus has been a burden many have poorly tolerated. Families are missing, couples have been separated; the disruption and the task of reconnecting is a great unknown. “I last saw my daughter a day after the storm hit… “

Medical issues range the complications of untreated chronic problems – asthmatics, diabetics, atrial fibrillation / cardiac problems, arthritic / orthopedic; plus new stressors of injury and infection.

Mental health issues are extensive, burdensome, and are difficult to address.

Complicating all these is a basic lack of clean water, simple food, underclothing, and shoes for bare feet. “If I could have just a shower… “

Financial complications with car, home, job are included in the phrase, “Nothing will be the same, “ for so many here.

The chapel is room and board for about 50 medical providers: physicians, nurses, EMTS, and more. It’s about a 1 mile walk through the lovely campus of LSU, to the P-MAC, now seeing patients 24/7.

I attended church on Sunday and one parishioner told a story, finding a family of four, parent and young kids, standing by their car in a downtown area of Baton Rouge.

He wanted to be a Good Samaritan, and offered them help -- perhaps a shower and an opportunity to so some laundry. The family had been living in their car for the past five days, and was greatly relieved at the parishioner’s offer. But they also wanted to bring the “rest of the family,” also in cars. Suddenly 15 people were chatting with the parishioner. Then, as word spread among the parked cars, this became an extended family of 37, ages from 1 to 87. The “family” stayed 36 hours, bathed, and ate and they planned to continue to drive north for potential resettlement.

*********************************
Saturday, Sept 3, 2005: This day had been spent at the P-MAC, the Pete Maravich  Assembly Center at LSU which has been accepting helicopters, ambulances and busloads of people who are the evacuees from New Orleans.

The mix of staff and volunteers is extensive. Border Patrol guards hefting M-16s provide excellent security, although the contrast with the lush, contemporary and stately campus exaggerates the effect. National Guard personnel provide the logistics of coordinating the extensive supplies, organizing the flow of patients and providers, and troubleshooting any rough spots. Nurses, docs, technicians, and eager students are all volunteers. The providers have been nephrologists, ER physicians, pulmonologists, orthopedic surgeons, and more.

Local physicians have been helpful with describing Louisiana "Good Samaritan" laws, which are applicable for volunteer medical providers in protection for liability concerns.

I was assigned to a team with two nurses, two techs (med students). The level of respect and communication has been excellent. Folks from this area are pleasantly surprised that health professionals have come from Ohio, Florida, and New York.

I have seen very few traumas, but mostly medically related problems, such as diabetics with foot injuries, dehydration, lost meds, cellulitis, COPD exacerbation, and many other acute-on-chronic variations.

The stories are multiple: Patient is status post CABG x 2yrs when the levees broke. Water entering the living room, and patient dropped the NTG, now floating right out of the house. Patient chases, winds up treading water for 30 minutes with substernal chest pain, finally rescued by patrolling boat.

Volunteer is radiology resident who ended 24-hour shift when Katrina hit; she stayed in a purgatory of providing care for patients for five days straight, through no water, no electricity, extensive bagging of some patients. Rescue finally comes for patients by helicopter, but the medical personnel are told to go to the hell occurring at the Superdome.

People overall have been positive and upbeat through miserable circumstances. I personally have been feeling very well accepted as a PA, working with my assigned team and the other providers.

It is a fine privilege to be in Baton Rouge today.