After the Storm Subsides

In the wake of back-to-back hurricanes Harvey and Irma, first responders and healthcare organizations scrambled to provide relief to those most impacted by the destruction of the storms. Search and rescue teams, physicians and nurses, EMTs, firefighters and law enforcement worked tirelessly to help ensure the safety of the displaced residents of Texas, Florida and the Caribbean islands.

EMS physician Benjamin Abo, DO, EMT-P, EMT-T  for UF Health , a specialist in austere and international EMS and medical team manager for Miami-Dade Fire Rescue Urban Search and Rescue Florida Task Force 1, is one of many responders who participated in search and rescue operations after the hurricanes. His task force team had been home in Florida after helping with Hurricane Harvey rescue efforts in Texas for less than 48 hours when they were deployed again to the Florida Keys after Irma struck. 

“We’re the tip of the spear for disaster rescue, so we’re the first to go in and do whatever we need to do,” says Abo. “The mission for this disaster was to seek out and identify surviving people and pets in the city of Marathon and identify needs for evacuation rescue.”

Abo and his 50-member team typically work from sunrise to sunset (or up to 24 hours, depending on the disaster), traveling through residential and commercial areas with the goal of clearing every single structure. They help transport or direct citizens to local hospitals and other resources for assistance. This disaster felt strangely familiar, though.

“We were doing full-mobilization exercises August 22–24 just outside of Houston, and then as soon as we got back, we then were deployed back to Houston for the hurricane,” Abo says. Not long after that they had to return to Florida because of Hurricane Irma. 

Despite the time crunch, Abo believes the exercise was highly valuable. “It was very, very helpful,” he says. “It gives people hope that we can respond and helps us have a real grasp on doing things.” 

As the one making the medical decisions for the task force, Abo not only takes care of patients but also his team and their force protection, whether it be FBI agents or the National Guard. He witnesses a broad range of injuries and illnesses on the job, including heatstroke, dehydration, animal bites, heat rash, hazardous-material exposure, and even fatal electrocutions due to power surges in the water. 

Abo adds that these are only additions to the list of conditions people already have that require medical attention, such as heart disease, diabetes and pregnancy. 

Everybody Has a Role

In the midst of disaster, Abo had positive experiences with people affected by the storms. “A lot of people are caring for strangers as well as showing graciousness. Texans were great hosts,” he says. Residents of the Keys have shown his team kindness as well. Despite losing their homes, local firefighters worked with his team every day to provide search and rescue assistance.

“I think everybody has a role,” Abo says. “We wouldn’t be able to do this medically if we didn’t have people covering our home areas. Likewise, we’re able to get as much accomplished as we are because of the local firefighters walking the streets with us, giving us local intel.”

Abo says every role, whether or not it’s a specialty, is equally important in the collaborative effort of first responders. “Everyone has their different roles and gets things done, and that’s the reason we’re able to take care of each other.”

Doctors and others involved in EMS operations in Puerto Rico, which only experienced tropical storm winds, extended the same care to the U.S. Virgin Islands that were devastated by Hurricane Irma. 

Edgar Diaz, public information officer for the VA hospital in San Juan, Puerto Rico, discussed current operations to provide aid to the islands affected by Irma. The effort includes the VA’s Federal Coordinating Center (FCC) and a partnership with the National Disaster Management System (NDMS). 

“This is the very first time our FCC has been activated here in San Juan…and to be able to support our brothers in the Caribbean,” says Diaz. 

Efren Méndez, Puerto Rico’s supervising EMS officer, notes part of the EMS system’s mission in the commonwealth is to support the VA with medical transportation. They provided 25 BLS and ALS ambulances to assist with transporting 180 patients with acute illnesses or injuries (122 of whom were dialysis patients) from the neighboring Virgin Islands, whose only hospital was destroyed in the hurricane. They have also received patients from non-U.S. territory islands in coordinated efforts with the U.S. Department of Health and Human Services. 

“We have a multidisciplinary team here in San Juan International Airport with physicians, EMTs, intermediate care technicians—who are veterans with previous medical experience in the armed forces—nurses, and a team of logistics and planning we organized to help the patients,” Diaz says. “We do triage, we match patients’ needs to hospitals’ capabilities, talk with the hospital and send the patients to the hospital.”

‘Practice Is a Payoff’

Gustavo Flores, MD, director of emergency and critical care training and crew member for REVA Air Ambulance in Puerto Rico, assisted with flying patients from the other islands to the airport in San Juan. “I’m involved in a volunteer fire-rescue team, and because many of our volunteers are also members of the different government agencies that were activated, we had to step up and cover for them and provide our share of care during the weekend operations,” says Flores, reflecting Abo’s view of the value of first responders’ different roles ensuring efficient patient care.

Florida Task Force 1 was not the only team that conducted an exercise oddly similar to Hurricane Irma’s impact. Cosme Torres, incident commander for the FCC, helped plan the exercise Tropical Journey 2017 in conjunction with the U.S. Department of Health and Human Services in April. The scenario involved a Category 5 hurricane hitting the U.S. Virgin Islands and the east coast of Puerto Rico, resulting in an influx of patients from the Virgin Islands in need of medical treatment. 

“Lesson learned: Practice is a payoff,” says Torres. “Everybody who is supporting this mission right now participated in Tropical Journey in April. Since we started, the communications between the DOH, the NDMS and even the airport operations have been synchronized and constant without any complaints or concerns.”

While the training exercise was indeed beneficial, it didn’t quite prepare providers for the magnitude of Irma’s destruction. “When we do the exercises, we usually come to prepare for a 24-hour operation,” says Héctor Alonso, MD, chief of emergency medicine at the VA hospital. “We’ve been ongoing for one week nonstop…it takes double the effort…receiving a constant flow of patients over a week’s span.” Still, Alonso believes it was “an amazingly helpful scenario.” 

Torres advises EMS personnel preparing for future disasters to “have some type of preplanning for this type of scenario,” like determining how quickly emergency operations centers can open and starting to pre-request support from health services, ambulance services and strike teams that can deploy quickly to areas needing emergency assistance. 

Aside from a few phone calls the night before Irma struck suggesting the islands might need help, EMS officials in Puerto Rico weren’t necessarily expecting the operation, but due to their detailed preparations, they were ready for an expedited activation.

“We learned how valuable the EMS system is,” says Torres. “The competence of the EMS staff is highly valuable in order for us to use the right resources on the ground to transport patients. It’s important because that helps get the right patient with the right condition to the right discipline area to continue improving medical conditions after a disaster like this.”  

Sidebar: Help Your Neighbors, Help Yourself

After disasters like major hurricanes, citizens can be instrumental in relief efforts, but they require instruction from EMS and other local officials about operating safely. What are the key messages we should emphasize?

First, listen to the experts. 

“Whatever the local officials are advising is the best advice to follow,” says Brent Myers, MD, MPH, FAEMS, president of the National Association of EMS Physicians (NAEMSP). “Your local emergency management, EMS, fire, law enforcement and public safety personnel know better what needs to be done than anyone else.” 

The NAEMSP provides educational materials and checklists based on best practices and lessons learned from previous hurricanes to ensure its members can efficiently plan and take action. For the NAEMSP’s most recent position papers on standard and clinical practices in disaster management, see www.naemsp.org/Pages/Standards-and-Clinical-Practices.aspx. 

Also tell citizens not to call 9-1-1 unless it is an emergency. Dispatch centers are often overloaded with 9-1-1 calls for incidents that are not absolute emergencies, tying up emergency resources for situations that require immediate aid. 

Most nonemergent 9-1-1 calls can be avoided since most injuries are preventable if people follow basic safety guidelines, Myers says. This includes wearing eye goggles and gloves while removing debris, bathing thoroughly after exposure to contaminated floodwaters and being cautious while using power tools.

Myers also strongly advises placing generators outdoors or in well-ventilated areas during prolonged power outages in order to avoid carbon monoxide poisoning.

Residents must also be mindful of their resting time and be patient waiting for services. “The recovery period is going to last longer than anybody anticipates,” Myers says. “Don’t work 14 hours the first day, because you may well be at this for several days clearing your property. Those who are affected have to just wait for those who are going to offer support.”  

Héctor Alonso, MD, chief of emergency medicine at the VA Hospital in San Juan, Puerto Rico, notes the value of citizens preparing before disaster strikes. 

“It’s important that people remain calm and have a personal plan to prepare to take shelter at home for three to four days so you don’t depend on the government and authorities while they get organized,” says Alonso. “Slowly, essential services are being restored, and people should look for instruction by local authorities on where to look for that information.”

“The most important lesson here,” adds Myers, “is that individuals will help their neighbor more than you ever anticipate. A lot of our role is to make sure that that is being done in a safe and appropriate manner.” 

Valerie Amato is assistant editor of EMS World. Reach her at vamato@emsworld.com.