A busy Saturday night in the emergency room pales to standing in the New Orleans Airport with thousands of potential patients.
It’s not just the volume of patients that is different, but also how medicine must be practiced when the usual rules are cast aside along with normal life.
Dr. Jeffrey D. Orledge probably felt as well-prepared as anyone could trying to treat Hurricane Katrina victims. The Medical College of Georgia emergency medicine physician has put himself in the path of disasters for years, working at various points as a volunteer firefighter, emergency medical technician, volunteer medical director for two emergency medical services programs and a member of a Pennsylvania Urban Search and Rescue Team in the aftermath of 9-11.
He was in New Orleans this time as deputy commander of Georgia 4 Disaster Medical Assistance Team, a Federal Emergency Management Agency-sanctioned team in development that may be called for backup as emergencies unfold outside its region.
Also this time, he had nearly two years under his belt teaching courses MCG helped design to impose order amid chaos. The National Disaster Life SupportAA courses offer a broad approach to disaster management.
The courses provide a disaster checklist, including detection, incident command, scene safety and security, support, triage, evacuation and recovery. “It helps people when they are involved in a situation understand the big picture a little bit better,” Dr. Orledge said.
Nothing
is more important than knowing who is in charge. Incident command depends on the
disaster and the location. In New York City, Mayor Rudy Guiliani coordinated
diverse disaster efforts. In the New Orleans airport where Dr. Orledge
volunteered, FEMA was in charge. In some situations and cities, it might be the
local fire or police chief. Participants in MCG’s disaster courses hash through
different scenarios, working through the disaster paradigm.
“The mass triage that we teach worked perfectly [after Hurricane Katrina],” he said. First, those who can walk are asked to group together. Those who cannot walk but can move are then identified, which leaves those who are not moving.
“People who are not moving are the first priority,” Dr. Orledge said. “You go and quickly assess them. Either you do something simple to help them move up to the next category or label them as ‘expectant.’” Physicians manning the critical-care tent then make treatment decisions.
Back in the busy emergency room on a Saturday night, extraordinary measures would be taken to save the most critically ill. But in a makeshift airport hospital, every effort is extraordinary. In the aftermath of Katrina and 9-11, Dr. Orledge has seen the frustration of having limited resources to handle massive needs.
“You as the provider only see your little piece of what is going on, and the whole scope is much, much bigger. It’s a different mindset,” he said. “You have to rely on the incident command structure. Once you realize where you fit in, the frustrations aren’t so bad.”
-- Toni Baker