Rebuilding from the (High) Ground Up

New Orleans EMS six months later

     How do you go about rebuilding an EMS department when most of the responders and even the director have suffered severe damage and displacement from their homes? That's the situation New Orleans, LA, EMS is facing six months after Hurricane Katrina devastated the city and the emergency department that serves it. Headed by Jullette Saussy, MD, whose title includes both director and medical director, N.O. EMS is a field unit system centered around a single base of operations. In such a system, all the assigned employees show up to the base before each shift and then are fielded out to locations throughout the city, based on the call volume need, as determined by system status management. The advantages of this system mean that Saussy and Deputy Director Mark Reis--both of whom had only started working in the department eight months prior to the storm--are in contact with everyone who works for them every day, and providers are close to an emergency call at any given moment. The disadvantages became apparent when flooding washed out that base, 25 of 40 vehicles, all the computers and the telecommunications systems.

     Today, Reis, spokesperson for the agency, makes a strong case that New Orleans EMS is in better shape than one might think. While frustrations are many in dealing with an ongoing disaster of this magnitude, there is also great opportunity when starting from the ground up. As one medic put it, "You don't get that many chances to start over, but that's exactly what we're getting to do."

     What they're looking at, says Reis, is an opportunity to standardize and back up communications with the rest of the emergency system, develop and integrate training practices with other public safety departments, and implement a unified vision of the Incident Command System and other organizational structures--an enviable position if it had not come at such high cost. But now, with the help of the Army Corps of Engineers and FEMA, including a $112-million loan shared with the New Orleans Fire Department, plus a sizeable Assistance to Firefighters (AFG or FIRE) Grant to set up a consolidated training center, among other things, once they're stabilized, the department is coming back strong. "We're good, we're running," says Reis. "We just have to make sure we're ready for the next hurricane season."

     While the EMS agency has recovered by leaps and bounds, there is still much to be done to prepare for that season, which is only three months away; and at press time, the Gulf of Mexico is already 10 degrees hotter than a year ago, he says. "That's bad for tropical depressions; it could be just as bad a year as it was last year for us. So, that's what we're focusing on now. We're not going to lose everything again."

     What have they accomplished, and more important, what have they learned that will help them when the next named storm hits the Crescent City?

     "The lesson learned is pretty simple," says Reis, "You go back to basics. Like most major metropolitan areas, we had a disaster plan. Obviously, that plan went out the window when we lost all communications and all ability to be mobile. How do you answer a phone call if there are no phones? Imagine all of the infrastructure that you had ever put together, all the computers, the electronics--they're gone. You just had to go out...on foot and in boats...and find people."

     Where do you start building an infrastructure? "On very high ground," says Reis.

     First order of business is stabilizing the organization itself. "It's like establishing a family: You stabilize your hierarchy, food, water and shelter; then the rest follows," explains the deputy director. Establishing command and control is the highest ground from which you can then build.

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