Katrina, One New York Physician’s Experience

Craig Mochson, MD, Attending Emergency Physician, Bronx Lebanon Hospital

“Emergency management experts agree that it is critical that providers not self-deploy to disaster areas, but rather align themselves with organized efforts being undertaken by the authorities and relief agencies in the affected areas.” Craig Mochson, an emergency physician from Bronx Lebanon Hospital, is an example of someone who did “self deploy”, but in an organized manor that proved to be useful. Here is his story…

As I prepared to head out for my last overnight shift before a scheduled week off, I found myself throwing clothes into a backpack, “just in case”. For the previous three days I had searched for an organization that I could join; FEMA, The Red Cross, The Medical Reserve Corps (which I was already a member), and a myriad of other public, private and not-for-profit agencies were all taking names, accepting forms and in the end, referring their applicants to each other. We were all waiting for further instructions from the Department of Health and Human Services to form the “forty, 250-bed field hospitals with 100 medical professionals per hospital…over the next few days.” That was already 4 days ago and nothing had materialized.

It felt, viscerally, like my day in the ER nearly 4 years ago on 9/11. There was a lot of information and misinformation, everyone wanting to do something, but what? I remember talking about going down to ground zero to help, with the majority of people saying it was better or safer to wait for instructions. I hopped on an ambulance and joined hundreds of other medical professionals from all over the world in a television studio turned makeshift hospital. We waited for patients that never came.

In between patients that night at work, I spoke to a colleague and NYPD deputy chief surgeon who was to leave with a DMAT team the following morning. I found out his deployment had been cancelled and the other teams already in Louisiana, were being pulled back. The danger and chaos in New Orleans had become too much. Soon after, I reached a live human being in the George Brown Command Center in Houston. “I’m an ER doctor from New York City. Do you need help down there?” I waited, there was a long pause, and then, “well yes, we could use all the help we can get.” That was all I needed to hear, Houston was far from the danger and chaos of New Orleans and I would not be using up scarce resources for myself.

Entering the Brown Convention Center was like walking into a city within a city, a giant space with impossibly high ceilings and florescent lights illuminating a cold cement floor. There were thousands of families clumped into small islands of air mattresses, their few belongings strewn about them in plastic bags, children were running and playing. A Sea of ‘yellow shirt’ volunteers moved about, pushing displaced persons in wheelchairs, entering data on missing persons, directing people to the unbelievable resources available to them. “Want to call a relative?” Tables of free phones over here, showers this way, and laundry over there. People came together from all walks of life, donating supplies and services. Clothes, shoes, toiletries, dialysis, day care, prayer sessions, missing people, food stamps, support groups, massage therapists, hairdressers, they all came by the dozens.

The University of Texas-Houston Medical Center, with just two days notice, organized the medical section of the convention center. Each section had an area leader in an orange jacket, with a hierarchy going up to the command center. There was computer registration, paper charts, triage, and metal poles with plastic curtains that created a color-coded maze of distinct medical areas: Adult Critical Care, Medical, Ob/Gyn, Cardiac, Fast track, Pediatrics, Immunizations and Mental Health. Ambulances stood by to transport patients to the hospital after initial stabilization and treatment if admission was needed. Piled high on neatly stacked palettes were tons of medicines and supplies. A truck was driven in that could do X-rays. Another area was filled with laboratory equipment and lab technicians. A doublewide house on wheels appeared to fill prescriptions for free. Two mobile RV’s showed up, one for dental care, the other for ophthalmology exams and free glasses. Audiologists and physical therapists were set up on the sidelines. Patients with diarrheal illnesses were placed in a 24-hour quarantine, where sinks were piped in and cots were set up for IV hydration. Each day brought a new generation of services and enhancements. Schedules and policies were written. A lab follow up office was formed. Insulin, syringes and controlled substances were held for patients who needed them and forms with hundreds of referral services in the area suddenly appeared.

The faces of the staff changed daily, as did patient acuity. In the first half of the week we saw acute MI’s, DKA and hypertensive emergencies, due to a lack of medications desperately needed by those with chronic disease. In the latter half of the week we functioned as primary care providers, performing blood pressure checks and medication adjustments for the patients we had previously stabilized. We were inundated with medical students, residents and retired medical staff. The local physicians had full time jobs, families, and lives to go back to. Therefore, it was the out-of-state physicians, the ones who ‘just got on a plane and showed up’ who formed the core of the medical group. For a week this was my full time job and I loved every minute of it. Physicians and Nurses from as far as Vermont, New York, Rhode Island and California showed up individually and provided an enormous service. As a doctor, it was one of those rare times in which the combination of medicinal supplies and staff who know how to use them met up with a population of people who are truly in emergent need during a disaster. I cannot express how grateful I am to have had the opportunity to participate. It was one of those rare times when taking a risk paid back with huge rewards, allowing me to do what I was trained to do and just be a doctor.