My friend's tale from New Orleans This is a personal account of the poster from my board that i mentioned here who got caught in the NO floods. The guy lost everything he owned.
One hell of a story, to be sure. We're holding a charity drive for him at my board, and auctioning off all kinds of A-10 type goodies from Dru Blair "thunderstruck" prints to Inert 30x173mm TP rounds, to an A-10 operations manual, all kinds of A-10 unit coins, and a bunch of other stuff YTBD.
Preparing this for some government officials this my first report on the katrina experience unedited for grammer, by no means is this exhastive or telling whole story.
Matt’s Story: A Refugee in My Own Country
A brief introduction, my name is Matthew Lottinger. I have an associate of science degree in emergency medicine from Delgado Community College and had extensive clinical training at Charity Hospital Trauma Center. I worked for five years in emergency medical services (EMS) as a paramedic during the late 1990s. Since 2000, I have been the President of a start-up telemedicine company, PatientCareRx (PCRx).
One of the proposed early projects of my company was a mass casualty management and treatment database system. The genesis of this system predated 9/11 based on my experience during the Hurricane George’s evacuation. After 9/11, we accelerated our efforts producing a primitive demo system that was championed by Dr. Keith Van Meter, head of emergency medicine at Charity Hospital. Dr. James Aiken refused to test the system then PCRx would not donate the systems to Charity permanently. This was a private endeavor; it did not seek public funds and had the attention of IBM. Yet the 2001 demo is relevant to the Hurricane Katrina disaster and what could and should have been done.
Hurricane Katrina: a first-hand look at emergency preparedness failures
I evacuated my wife and baby daughter on Saturday, August 27 with full knowledge that I was going to stay for the duration to:
1. Secure my business and off building for my landlord
2. Post storm I had a clear plan to seek out where I could put my medical knowledge to good use helping people
At 4 pm, the night before Katrina, I was informed that my grandfather Ellis Peter Lottinger and his fellow residents were not going to evacuated from Metairie healthcare Nursing Home to Jackson as had been stated in their disaster plan. As a grandson and as a paramedic, this shocked me. I had participated in the evacuations of all the nursing homes in the New Orleans metropolitan area during Hurricane George. After George, all nursing homes were to have an executable plan for hurricane evacuation. When I called the nursing home, I was told, “no one told us to evacuate.” I would later find out that my grandfather like so many elderly nursing home patients was evacuated by plane, adding an estimated $1000 to the cost of evacuating nursing home patients. In addition, each patient had to be housed in hospitals at a premium over the cost of a special needs shelter or other nursing facility, creating a possible impediment to take care of critical care patients who needed urgent medical treatment. Even more distressing is that subsequent news has shown that some nursing home patients were not evacuated and left to die. A cost analysis is needed based on the failure to evacuate nursing homes. It is possible that it will be in yet another avoidable cost, escalating into the millions. If the nursing homes retain control of the patient in any way, the nursing homes could also still be receiving state and federal funds.
Post Katrina Chaos and Safety
When Katrina hit, my office lost all power and its roof. Otherwise, the building was intact. I spent Monday and Tuesday in the building, located at 1001 South Broad Street, New Orleans and known as ArtEgg Studios (www.artegg.com). From this vantage point, I was witness to rampant looting. I and one other man had significant fear of bodily harm from the general lawlessness.
On Monday morning, I called 911 reporting the looting of Coleman’s Urban wear, located at the corner of Earhart, S. Dupre and Euphrosine Streets. The looters were streaming out of the BW Cooper Housing Development. Later, it was reported that a police officer was shot at Coleman’s. During the looting, I took 10 rolls of 35mm film. I gave this film to the Times Picayune, which is directly across from ArtEgg. When I was taking pictures, the looters would look directly at the camera and smile. During this whole period, I was armed with a 9mm pistol on a hip holster to act as a deterrent. The film was turned over to Mr. Bernard, head of the Print Shop. This film will show the chaos. It should be noted that Coleman’s had no food or essential supplies.
On Tuesday, the water continued to rise and my associate and I tried to re-float a boat that was in the back parking lot with bilge and sump pump. Over a six hour period, the water rose two ˝ feet. I had taken photographs to document this, but they were stolen at the Superdome. I received a phone call at 10 am on my cell phone from Dr. Keith Van Meter at Charity Hospital. During our five-minute conversation, he informed me that the hospital was being evacuated. I asked him where I could go to volunteer and he said that military was in control and he was unsure if I would be allowed to volunteer. At 5 pm on Tuesday, it was becoming clear that the water would continue to rise. Without our generator, we would have had no knowledge of the outside world. At the same time, people were looting Universal Furniture on Earhart, stealing mattresses, televisions, refrigerators, and sofas. The looters were coming out of the Cooper Project in full-view of the helicopters circling overhead. The looting was well organized and included children and adults of all ages working in a coordinated fashion.
At 7 pm Tuesday, I decided to push-pole the boat out alone with some tools to see if I could help others. My associate decided to stay behind where he felt safe. I left him with my dog with the understanding that he would swim out on Wednesday. My dog Arte was to be left behind with food, water, and the full run of the building. At this point, we had not seen New Orleans Police since a brief response on Tuesday.
I was unable to push-pole the boat and was alone with the current. The boat began to sink. None of the helicopters I signaled responded. At approximately 11 pm, I decided to swim to the Superdome due to the increase in random gunfire. In order to swim down Europhrosine to S. Dupre then up Earhart, wearing a left vest, swim fins and towing my luggage behind me. This path took me directly in front of the BW Cooper Housing Project where people were firing fireworks, guns, and playing loud music. I turned off my flashlight and floated by as much as possible. Where it was too shallow, I crawled on my hands and knees. There was total lawlessness.
Once I arrived at the Claiborne/Earhart overpass, a man with a flashlight who shone it on me confronted me. He said he wanted $20 for shining the light on me and then said, “put your shoes on. They’re coming after you.” He also asked me for drugs. I climbed back in the water and swam about one ˝ miles down the Corondolet off-ramp. At the overpass, I vigorously attempted to flag down local and state police units with a flashlight. The units kept going despite the curfew – I should have been arrested – it would have assured my safety.
I crossed over the center guardrail and then trekked 1.5 miles to the Superdome, taking the Claiborne exit. I got into the water again and ended up in the Superdome garage. Once there, I found soldiers who made no effort to help me and directed me to three wrong entry points. Someone from FEMA finally sent me to the Claiborne entrance. I was allowed to join the crowd at approximately 2 am Wednesday. No first aid, water, or food was offered. A National Guard sergeant, afraid and unarmed, advised me to sleep outside, due to the odor from urine and feces. I was told that a man raped two children who were less than 12 years old. I was told that they were leaving the blacks die and I was on the wrong side of the National Guard yellow line since I was white. I was offered cigarettes for $10 a pack. The night before was characterized as a “near-riot.”
I slept where I sat outside the Superdome. At 7 am, I was told that 800 buses, helicopters, and Amtrak were coming to the rescue. At 8am, I tried to get my first bottle of water and medical care for the open wounds on my feet. After wading through the Superdome in my sandals on a floor covered with urine and feces, I found the first air area, staffed by a volunteer pain management physician passing out Tylenol and Advil. There was no betadine, no soap, no gauze, or any other wound care products. I was poked at by the physician who told me to pour water over my feet and keep them clean. The fact that I am a diabetic did not register. I was given an alcohol prep pad to clean both my feet. I want down to the National Guard water and food center where I was refused water to drink or clean my feet for six hours (11 am to 5 pm). Soldiers were allowed to have water.
At this point, I had been without water for 15 hours. I sat and begged for water. A fellow refugee shared one with me. At 12:30 pm, people started stealing water from the National Guard carts as they passed. A high-ranking officer finally came by and water was released to the crows. I was given four .5 liter Forced to choose, I had to drink them rather than clean my feet. All around me, people were fighting for water; some young men were stealing water by the case.
After receiving drinking water, I went back to the first aid center to find it abandoned. I met two military medics and explained that I was a diabetic with foot wounds that were red, infected and swollen, and needed basic cleaning. When I told them I took Glucophase, I was told I did not qualify for care per protocol. I was then told to find a physician from Acadian Ambulance at the exit across from the Arena. He mocked me stating that this was a disaster and gave me 3 pieces of non-sterile gauze and 3”of tape to dress my wounds. When I told him this was a f----up and that it was poor planning, he shrugged it off. He mocked me again for not being able to stand in line due to the pain. “Oh well!” said he.
By nightfall Wednesday, I had to beg a fellow refugee for food because I could not stand on my feet due to pain and swelling. Only the strong and healthy could stand in line for food. I slept outside on Wednesday - by this time, the National Guard refused to go into the crowd to get a seizure patient and those who were unresponsive in the crowd. I exchanged words with one and an NOPD officer stating that they needed to get the Mayor, General, or Governor here to address the crowd letting them know about their future. Every question asked of the National Guard was answered with “I don’t know.” The NOPD officer told us “we should be grateful somebody was helping us. Why in the hell don’t we leave?” It was phrased as if the lack of help was punitive. As more people began to fall down, I started to take charge of getting people carried out by cot to National Guard lines for care. I was assisted in carrying three unresponsive post dictal seizure patients, who had been without Dilantin, leading to less than adequate drug levels head off seizures. I then began treating asthma patients in the crowd, requiring me to listen with an ear to their chest for wheezing. Some patients had their air compressors for albuterol treatments. We had to ask permission form one of the me to set up cell phone charging station in the Superdome’s back-up power system, after we had been turned away from other cell phone charging stations. He allowed us to plug in and was very helpful.
I was able to get two patients started on breathing treatments. Once back in the crowd, I found a large pregnant woman who was barely breathing and unresponsive from an acute asthmas attack. We carried her to the area where the other asthmas patients were. One of my other patients gave me one albuterol treatment to give to her. Breathing improved 100% and the patient began to vomit and have abdominal cramps after half a treatment. The National Guard Lt. finally came to carry the pregnant woman out. I tried to strike a truce with him after the patient was evacuated. I asked for permission to move sick patients close to the National Guard lines – I was denied based on tactical concerns. After going back into the crowd for another seizure patient, I was finally offered a chair behind the National Guard lines and was allowed to bring along three elderly diabetics and one 5-month pregnant woman who was having contractions. Once the diabetics were fed, their mental status began to improve. The pregnant women was sent back to the arena and triaged for a flight out. Later that night, at about 3am, another diabetic who had been outside without water was found by his family with decreased mental status. I met with the family and set them to slowly feeing him candy. Then he became more aware of his surroundings. The family was then able to provide him with food and water.
By 7am Thursday, we were beginning to line-up for buses. Young men were inhibiting the free movement of the elderly and infirmed. I moved one elderly couple to an evacuated area with their son who said the military told them they did not qualify as elderly. The mother was wheelchair-bound with contractures and about 80 years old. The father was 80 plus. What is the definition of elderly? Where is the common sense? How was it possible to have such insensitivity?
As I lined up at the Poydras exit, a woman came up begging for help for her mother. The National Guard said she would have to carry her mother to them. Out of frustration, the woman began threatening the lives of the Guardsmen if her mother died. I went to the women and asked her to take me to her mother. The mother was confused and dehydrated. She had a history of hypertension and heart problems for she was taking diuretics. Her water intake was poor due to lack of access to available water that was being hoarded by other refugees. The daughter and I begged for water from a man sitting on two cases. Once the mother was hydrated, she began to feel better. I told her not to take any more medicine until she was evacuated or could find more water.
A National Guardsman ran through the crowd asking for medics. I identified myself and followed him as fast as I could to Henry, who was barely breathing and dry to the touch. I instructed people to place him on a cost and carry him to the closest EMS spring vehicle. While carrying him, I had to open the man’s airway with a jaw thrust. His respiration was shallow at approximately eight breaths per minute. When we got to the EMS unit, the vehicle was locked. I told the National Guard soldier, it was life or death and to break into the unit. He told me he could not do it but I could. I took a leg from the cot, tried to smash in the back window, and could not. I went back to treating the patient while other refugees took and managed to smash the tempered glass. Once the unit was penetrated, the National Guardsman began to remove the necessary supplies. I had to teach and direct him and fellow refugees in what equipment was needed – there were no other medics available. One of my refugee colleagues informed me he was only a nurse – not a doctor. I told him to act like one and calm the crowd, which was becoming increasingly restless. I ventilated the patient with high-flow oxygen via a big valve mask. The patient had a gag reflex when I tried to place it in the oral airway. With aggressive ventilation, the patient’s color improved. I then attempted incubation twice but was unable to see vocal cords and the patient. We decided to move him to the helipad for evacuation while being ventilated. The patient’s color improved significantly by the time we arrived there and he gradually became aggressive. Once at the heliport, I was told to calm down, military triage was in place. No one assisted me. One Acadia Ambulance medic told me he was not there to provide care.
As Guardsmen began to assist I found a nurse who was a colonel in charge of triage, I requested a flight to a hospital. Colonel refused the flight, refused to transport after consulting with officers. I was told that Henry would have to be taken back near the crowd area to die. The colonel quite proudly said she knew of another patient in the Area dying of impending respiratory arrest. I told her I would take Henry back up near the crowd and sit with him while he died. Note at this point the patient was semi-conscious with a normal sinus rhythm. As I wheeled Henry in view of the crowd, soldiers were crying. A Sgt. Ogden tried to find help from other officers. I saw at least one other colonel crying. A Sgt. provided me with some paper and as Henry became fully conscious, I informed him he would not be going to the hospital and we should write his family. I told him several times, I could not bring him to his cardiologist at East Jefferson Hospital. We came to an understanding that I would get him cooled off and orally hydrated and if he stopped breathing again, I would have to let him go.
As I was treating Henry, approximately 10 patients arrived in various states of heat exhaustion and heat stroke. One woman was about 5 months pregnant and barely responsive. I instructed her husband to slowly give her water orally. We had to scrounge for water for water from other refugees since the soldiers would not give it to us – until Sgt. Ogden got us about 4 cases of water. Each patient was thus able to have 2 – 4 liters of water. The Sgt. brought his medics to help. One medic, St. Hernandez, was very helpful. Sgt. River was rude and combative with patients initially but gradually came around as patients began to improve.
A colonel came by the makeshift treatment area stating the FEMA left only one Air Force medic staffing the arena clinic. We decided to move my patients to the clinic so I could assist in the treatment of pregnant women in the arena. The initial plan was to work hand in hand with the Air Force medic. When I introduced myself, and found the Air Force medic starting or having started to administer IVs of normal saline wide open on several patients. The medic gave no reason but left – just telling me he had to go.
I was immediately forced to organize refugees into teams to provide some semblance of a clinic staff. I found one man who was organizing supplies and told him to organize them by category. I was able to organize two women to start creating patient charts. There were also several men who were already providing labor to carry patients and remove trash. By pairing the men doing the heavy lifting with other people who were able to clean, we were able to get the clinic cleaned and ready for patient treatment. The heroic efforts of my fellow refugees showed me that massive amounts of human resources were not being tapped – we could help ourselves. This is an important lesson – it is not the military, FEMA or other government or quasi-governmental organizations that will help the people – it is the people who will save themselves if they are supported, card for, nurtured, and guided. This concept is based on the concept that the people help themselves since they outnumber government resources by at least ten to one – especially in the beginning. During the first critical days of life and death, FEMA should have engaged the talents of the refugees to help themselves and their fellow man survive.
I began to triage the patients FEMA left behind. One man had been bleeding from a facial wound for 15 hours and was in shock. Since this in jury was cause by a domestic violence attack by his girlfriend with a bottle, this African American man was left in a corner out of view. It pains me to come to the opinion after much soul searching that people were being treated based not on need but on value judgments. I firmly believe there was no strong guidance to ensure patients were protected from our bias – based not on race but based on what can be characterized as low-class behavior. Everyone has these biases and due to the crime in New Orleans, we all were challenged to suppress them. In order for the clinic to rise above the perception of racial bias, social behavior biases must be suppressed. If the social biases are not suppressed patients are triaged based on perceptions. The patients did it to themselves and since many of the patients in New Orleans are minimally educated African Americans, this snowballs into race-based triage. It is not the faulty of individual patients that the local education system has failed then so badly. Despite this, while many refugees were less than articulate, or obviously un-educated, these people brought a unique and valuable skill set. These skill sets were cleaning, hygiene, and heavy labor to move patients. We need to recognize the strength of those volunteering and strive to get them past the social triage pitfalls.
As I continued through the triage process, I found:
1. The dialysis patient who was not evacuated
2. Approximately 5 cardiac patients
3. Six pregnant women at various states
a. One woman who was 4 – 6 months along with cramping, spotting, and having clots. It was obvious she had lot her child.
b. A six-month pregnant woman with a high-risk history. She had stayed in town to be near her doctors.
c. A woman who was 8 months pregnant with strong contractions 4.5 minutes apart.
4. I found a woman and her newborn baby that had been delivered in the Arena, the day before. It was shameful that no efforts were made to evacuate or provide basic monitoring. Who was running the place?
5. I found a patient with severely reduced mental status. He had a history of diabetes and the Air Force medic had started an IV of normal saline running wide open. The medic made no effort to ascertain the patient’s glucose level and give glucose to see if that would improve the patients’ condition. We gave the patient ˝ amp of DSO and oral glucose with no improvement. Over the next few hours, the patient gradually improved for unknown reasons. However, I took the time to prepare the patient’s family for his death.
6. Asthma was by far our most prevalent problem. There was no oxygen available for albuterol treatment.
As I was also triaging patients, I met Dr. Bennett Nwan KPA, psychiatrists, from New Orleans. He was already treating patients and was a boon to all of us. We quickly divided labor where I would screen and try to organize patients. It worked well. Dr. Nwan ordered me to a DSO Challenge of patient with diminished mental state, when we could not find the glucometer.
General Lupin arrived at the clinic and immediately thanked both Dr. Nwan and me for our help and promised aid. He came back with the heliport triage nurse who avoided speaking with me. The impression I got was I challenged her authority and she wanted nothing to do with me. Immediately General Lupin presented several of his military doctors to triage and evacuate patients by choppers. Note on Thursday, none of the military medics or physicians were permanently assigned to the clinic. The National Guard officers stated they needed their medic elsewhere - I find this appalling since they were not treating civilian patients. What were they tasked to do? Were they hoarding their own resources to treat the military?
By approximately 2 pm, we had cleared out all patients by military helicopter. I attempted to fly out twice by helicopter but both times, I was sent back to the arena when the helicopters stopped flights at night. I slept in the clinic, two military nurses cleaned and bandaged my feet for the first time while I slept – they were angels. Dr. Nwan worked all night - his dedication was awesome.
On Friday morning, the military had taken over the clinic and the FEMA mobile hospital arrived. I helped for about 4 hours on Friday morning then was evacuated to the airport. Once there, much of my times was spent calming a patient I had dealt with earlier. I was amazed when one woman took over organizing the disposal of trash and cleaning up. However, you could see the military teams were not happy with her loud orders. As for the DMAT teams from all over the nation, I was very grateful. Yet if this was the aid of the local governments, we were counting on them, – we were delusional, and some of these DMAT teams were from Alaska and Hawaii.
Once I was flown out to Kelly Air Force base, I was met by a well-oiled machine that quickly handled admissions and care at Nix Trauma center. Dr. Ralph Wills and his staff were great. Over four days, IV antibiotics for cellulites of my feet – at considerable expense to the taxpayers – I was discharged.
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