Disaster Response Volunteers Remember "Little Miracles"
And Dedication of Fellow Responders in Post-Katrina New Orleans

By Paul K. Mueller I September 26, 2005

Back row Center: DMAT Commander Dr. Jake Jacoby, Emergency Medicine; Carla van den Hout, Dr. Christian Sloane, Emergency Department. Second row: Susana Leung, Pharmacist Front row: Eileen Callahan, Public Information Officer; Dr. Hal Forney, Orthopaedics. Not shown is Co-Commander Therese Rymer, Emergency Preparedness & Response; Mark Reeves, UCSD Chaplain; and Dr. Colleen Buono-Kraska, Emergency Medicine Fellow in EMS/Disaster Medicine.

During one high-pressure episode at the Louis Armstrong Airport in New Orleans - packed with evacuees from the hurricane-flooded city, many needing immediate medical care, most separated from families and possessions - Therese Rymer turned to a police officer working with her to help an older man who'd collapsed in a bathroom stall.

"I'm Therese," she said, offering her hand.

"I know," he said. "We've been working together for three days."

That's how absorbing and intense her experiences were, says Rymer, a UCSD Medical Center nurse practitioner, as she and fellow members of the San Diego Disaster Medical Assistance Team (DMAT CA-4) focused all their experience and skills on the "massive influx" of people who arrived at the airport after Hurricane Katrina swamped their city.

They worked with similar teams from around the country, and with Air Force and Air National Guard personnel, to prioritize the thousands of medical cases flocking to their tents within the airport; to give immediate treatment to those most in need; and help get others on buses or airplanes to medical facilities elsewhere.

They also, says Rymer, helped achieve some "little miracles" of finding lost relatives and keeping frightened groups together in the confused swirl of too many people in too little space.

One such little miracle: "An autistic man arrived at our station, unescorted, and without the ability to communicate. Because of our triage system, if he didn't need immediate medical attention, we'd have to put him on a flight out - something we didn't want to do," she says. "When we realized his hand motions weren't sign language, somebody gave him a pencil, and he began writing his name over and over again. With that, we were able to find his mother."

Brisk and efficient when discussing medical issues, softer and quieter when describing the human pathos of her patients, Rymer speaks with feeling of the evacuees' desperation and confusion. "I'd make sure to touch them, to look them directly in the eyes, to be certain they heard me," she says.

She remembers that people formed groups on the basis of bonds both sensible and flimsy - patients from the same ward in a flooded hospital; people from the same part of town; people rescued by the same helicopter. She especially recalls one woman who "adopted" four elderly women who would otherwise have been lost and helpless in the throng. They were complete strangers to her, but she took charge of their care.

A mother tending an adult son with severe medical problems, facing the loss of her home and all of her worldly belongings, told Rymer, "I don't look to yesterday or look to tomorrow - I just look to today."

DMAT San Diego CA-4 paramedic Jim Lang listens to the story told by a victim of Hurricane Katrina.

Because of the medical team's system of priorities, called triage, patients who could wait for treatment were directed to vans, buses and airplanes going to a variety of locations. "These people, many separated from their families, with no possessions or records, some without any ID, had to decide pretty quickly where to go - most of them without any basis whatsoever for their decision. You can imagine the consternation and confusion."

Rymer and her team were able to avoid confusion themselves because of their participation in previous disasters and a lot of training, she says. The DMAT CA-4 team is composed of doctors, nurses, emergency-medical technicians, mental-health workers, logistics and administrative staff, medical support personnel, and a chaplain. The team is led by Dr. Irving "Jake" Jacoby, an emergency-department physician at UCSD Medical Center. "

Our DMAT unit was founded in 1991," he says, "and our deployment for Hurricane Katrina is the 14th federal deployment as a team." Among their assignments were deployments to Guam for Super Typhoon Pongsona in 2002 and Ground Zero in New York City following the terrorist attacks of Sept. 11, 2001.

Jacoby wants to make sure that everybody involved is recognized. "Many thanks need to be extended to our physicians, nurses, paramedics and EMTs, pharmacists and technicians, and our logistics and support personnel for making this deployment the greatest in our history, and for doing their jobs the best they knew how - particularly in such austere conditions, and with such an overwhelming scenario."

"We always have many more volunteers than available slots," Rymer says. The San Diego team usually comprises 36 people, 31 of whom were deployed on Aug. 29. Others have joined the effort, too, so that 41 team members were deployed by mid-September.

Rymer is director of the Medical Center's Emergency Preparedness & Response program; she is also deputy commander for DMAT CA-4. As part of her disaster-response duties, she's recently helped the victims of Hurricane Dennis in Mississippi and was a volunteer sent to serve victims of the major earthquake that struck the island of Nias in Sumatra. Multiple other deployments and DMAT training exercises prepared the team for the rapid response to Katrina.

"We were activated on the 28th of August, and were in flight with our gear on the 29th," she says. "We flew into Houston on Monday night, and were moving the team by 5:30 a.m. on Tuesday, heading for Baton Rouge. We were redirected to Louis Armstrong Airport in New Orleans at 11 p.m.

"We arrived at a darkened and closed airport in the wee hours of the morning. Several hundred stranded people slept on the floor of the airport terminal. We surveyed the terminal, set up our triage tents in the concourse, and began seeing patients before 11 a.m. That 'pod' kept us busy until 4 a.m. the next morning. We'd treated about 1,000 the first day. The fatigued team slept on the luggage conveyor-belts."

Richard Liekweg (left), chief executive officer of the UCSD Medical Center, welcomes Dr. Jake Jacoby home after the doctor's medical-assistance team returned from New Orleans.

Then, says Rymer, a "massive influx" of evacuees began arriving at the airport - several thousands of people transported by helicopters, buses, ambulances, trucks, and cars - and with them came patients, many in wheelchairs or on gurneys, many without records.

"The place was absolutely packed," says Rymer, "and we had to focus on getting the patients sorted by severity of case, especially anybody who couldn't wait for 24 hours. We had new mothers with infant babies, diabetics who'd been without their meds for days, patients carried from nursing homes. We were all intently focused on doing what needed to be done, getting people the treatment they needed, moving others forward to make room for more."

The medical team evaluated injuries and conditions of every kind, from heart attacks, seizures, and head injuries to dehydration and infections. Their work was complicated by some patients' inability to communicate, lack of records, sporadic depletions of needed supplies, and the necessity of cycling patients through the airport and out to better medical facilities.

Communication was a major problem, she says, but the media "partnered" with responders to get vital information out to the public.

The team worked for eight days at the airport, and officially triaged and treated about 2,500 patients during the first four days - the exact number will never be known.

"My colleagues, our counterparts on other teams, and the Air Force and Air National Guard people were working to the nth degree,"says Rymer. "We ran out of triage tags and paper medical records, and had to improvise with what we had. I saw incredible innovation and cooperation. It was an honor to work with them."

The direct, plain-spoken nurse will not second-guess the post-Katrina response. "Things changed very rapidly," she says. "In the midst of that sense of being overwhelmed, our team and others pooled our training, our experience, and other resources, and did what we could."

Jacoby, too, credits the extensive training conducted by the National Disaster Medical System and its response teams for their ability to adapt and persevere. "In this case, we were able to be involved in the initial setup and triage," he says. "We were forced to use skills, both medical and organizational, that we have trained on for years. This was a full disaster response. I am extremely proud of the performance of our entire team."