Copyright 2006 U.S. News & World Report
All Rights Reserved
By CORY HATCH
U.S. NEWS & WORLD REPORT
It’s 3:30 p.m., and first responder Linda Thompson is rushing toward her 10th emergency of the day: Edward Williams Jr., an 84-year-old man with a history of both triple and quadruple bypass surgery, has reported pain in his neck and jaw. When the East Jefferson, La., paramedic arrives in her SUV, she takes Williams’s vital signs, asks about his medical history, starts to attach a monitor-defibrillator to his chest — and wonders what happened to the ambulance. “Where’s my transport?” she shouts into her radio.
The drama that defines a paramedic’s workday has shot to a whole new level in post-Katrina New Orleans. The city itself is still missing half of its citizens, so the New Orleans EMS service gets only 60 percent of the usual ambulance calls. But in surrounding communities like East Jefferson that escaped the worst flooding, the population is back, swollen by city residents moving outward and natives returning. Ambulance fleets and staffs have taken a hit, and many of the people who call 911 are sicker than before the hurricane; they often haven’t had access to medication or doctors for months. Williams has developed diabetes and an antibiotic-resistant lung infection, for instance. (His ambulance pulled up shortly after Thompson’s call.) To make matters worse, only nine of the metro area’s 16 acute-care hospitals have reopened; paramedics, who must stay with patients until a doctor or nurse shows up, might wait two hours in the ER hallway. “It’s just been hell, what can I say?” Thompson reports. “It’s like a Wild West video game.”
Big holdup. While ambulance crews wait in crowded emergency rooms, they can’t react to the next crisis. As a result, East Jefferson’s average response time has increased from about seven minutes pre-Katrina to about nine minutes, a big difference considering that brain cells start to die after roughly five minutes without oxygen (though still not bad compared with the national average of nine to 10 minutes). East Jefferson lost two of 13 ambulances to Katrina. And those on the road don’t always get where they’re going. Earlier in the day, a West Jefferson ambulance attempting to help out broke down on the way to the call; the one that finally did arrive limped to the hospital with a broken transmission. Nine of 34 paramedics have moved on, and ambulance crews sometimes offer to work up to 80 hours a week.
With 25 new ambulances to replace those lost in the flood, an intact staff, and fewer-than-normal 911 calls, the City of New Orleans EMS is less strained than its neighbors. But crews are keeping a wary eye on the calendar: The next hurricane season starts June 1. The directors of the service have revamped their disaster response plan in anticipation. During Katrina, a communications network that relied on cellphones and radios failed. Next time? Crew supervisors are empowered to act independently — much as three take-charge EMS administrators did last summer when they set up a treatment stop along Interstate 610. There, paramedics gave dehydrated residents intravenous fluids before loading them onto evacuation vehicles. This “treat and release” approach isn’t normal ambulance protocol, but it worked.
Not surprisingly, the stress has taken a toll on first responders, says Howard Osofsky, chair of Louisiana State University’s Department of Psychiatry and head of a group of mental health professionals who provide counseling to any who want it. While amazed at the resilience they’ve seen, Osofsky and the team are diagnosing significant depression, post-traumatic stress disorder, and anxiety about the future, including the next big storm. “People have said, ‘We can’t do this again,’” notes Jullette Saussy, head of the New Orleans EMS service. “People are tired, and it’s not the type of tired that goes away with sleep.”
Also read (Full Text Online access required):
EMS & Crowded Emergency Departments — March 2006 EMS Insider.
Legal Consult: CMS & Nevada Address ED Patient ‘Parking’ — February 2006 EMS Insider.