Polite Dissent

Last night, I was one of two physicians on hand as a plane full of New Orleans evacuees landed at our small airport. Our clinic provided 5 people (2 physicians, a physician’s assistant, a nurse, and a medical assistant) and our senior physician was in charge of the medical operations on site. Our job was primarily one of triage — deciding which patients need medical care and how quickly — rather than hands on medical care.

People straggled off the plane one or two at a time, clutching plastic bags filled with toiletries and other belongings. Several people held on to their cats and dogs tightly as well. As they stepped into the terminal, we’d give them a quick medical look-over and make sure they were doing OK. Volunteer greeters came up and directed each passenger and family to food and water and helped them fill out the necessary forms. After that was accomplished, they were taken to the first floor for more food and then loaded on buses to take them to their lodgings.

The evacuees were amazing. There was no evidence of the desperation that had been mentioned on TV so much. They were polite, well-behaved and did a tremendous job looking out for each other. I can only hope that I’ll have that much presence of mind in a similar situation. In fact, most of them had just been rescued from the city that morning or the day before and had no idea which airport they would be ending up at.

Medically, things went smoothly. As soon as the plane taxied to the terminal, an advance team consisting of our physician’s assistant and medical assistant went aboard. They conferred with the Sky Marshals and started sending out passengers a few at a time. The Marshals were excellent at identifying people with medical concerns and these were brought to the attention of the physicians in the terminal. Even after all the evacuees had disembarked, we continued to circulate and talk with them. Several medical issues did not become apparent, or were not mentioned, until well after the plane had landed.

We used a three-tiered triage system. The first tier was medical emergencies. These patients were sent immediately by ambulance to the nearest emergency room. The second tier consisted of patients who needed medical care, but weren’t true emergencies. These patients were sent to one of the local hospitals for evaluation and treatment that night. The third tier were the evacuees who did not need medical treatment at that time. This was by far the largest group. They were sent on to their lodgings, but a free medical clinic would be available for them the next morning.

We had one medical emergency: a patient who complained of chest pain. She was immediately transported to the ER. Fourteen other patients were ultimately sent to the hospital for evaluation as well. There were several patients with infected wounds or sores, a few fractures and at least one sickle cell crisis. We were aggressive in sending patients for further medical care, including patients that we probably would not have sent under normal circumstances. For example, I would send any patient with an open wound for further evaluation. The water down in New Orleans is nasty, and I suspect most of those wounds were infected.

Someone had been smart enough to arrange for veterinary care, and the veterinarian was the one of the busiest people there. She cared for seventeen cats and dogs, from a three-week old kitten to an eighteen-year-old dog. Many of the animals were dehydrated and needed IV fluids. Several had open sores that required treatment. She was aggressive in immunizing the animals against Bordatella as well.

In less than two hours, over 160 people and nearly twenty animals had been processed, evaluated, fed and sent on to their first clean bed in a week.

Rumor is that we’ll be doing this every couple of days for the next few weeks.