Michael J. Sohmer, BS Pharm./EMT-1, FASCP
DMAT San Diego CA-4
Six of us, which included one Nurse supervisor and myself the Chief Pharmacist of CA-4 along with 4 logistics officers departed San Diego in three 24 ft trucks on the early evening of Sunday Aug. 28th. We arrived at LSU in Baton Rouge, Louisiana on Wednesday August 31st in the mid afternoon. The Chief Medical Officer was requesting any and all available Pharmacists so I proceeded to the makeshift Pharmacy intake area at the Carl Maddox Field House. After several hours of chaotic ordering and dispensing of medications, the 6 of us left Baton Rouge and drove to the Louis B. Armstrong New Orleans Intl. Airport. Arriving in the early evening, we joined up with the rest of our team, DMAT San Diego CA-4. The team had been there since the evening before and was one of the three teams first deployed to the airport. Since there was no running water, power nor air conditioning, we thought it prudent to leave our Rx cache in the refrigerated FedEx custom critical truck to maintain its stability, as the outside temp was 94 degrees plus and possibly into the triple digits inside the airport. We dispensed medications out of that truck for the first 36 hours, enduring the ear shattering compressor as well as the near-freezing 40 degree temp. When power finally did come on, a day and a half later, we commandeered the "New Orleans Legends Bar and Grill" inside the airport concourse. We set up a Field Pharmacy behind the bar and proceeded to fill all of the medication orders that were thrown at us.
Besides myself, our initial staff included, 2 members from my team CA-4, Pharmacist Susana Leung and a Pharmacy Tech, 2 Pharmacists from WA-1 Charlie Valencia (actually a back fill from OR-2) and Pharmacist Hurley as well as Pharmacist Delgado from Tx-4. After several days we finally got augmented with more staff which include OR-2 Pharmacists Grunow and Parks as well as MA-2 Pharmacists Mastrodomenicao and McEnaney, Pharmacist Gutfleish from FL-3, and Pharmacist Gervase and Pharmacy Tech Dreisbach from PA-3. The USAF stepped up to the plate by sending us Pharmacist Lequatte and Pharmacy Tech Condron whom both proved to be invaluable to us. When it was all said and done we had 14 pharmacists (13 DMAT, 1 USAF) and 3 technicians (2 DMAT, 1 USAF). We were a 24/7 operation, manning shifts from 0700 to 1900, 1200 to 2400, and 1900 to 0700. In a 6 day period our DMAT teams triaged and treated well over 23,000 and 2600 patients respectively, and we amazingly filled over 5500 handwritten prescriptions, as we had no Pharmacy software program provided to us that could print labels.
Rescue victims and evacuees came mainly from downtown New Orleans and the surrounding Parishes.. Patients were being transported to us in a 24-hour continuous array of ambulances, buses and helos which included Blackhawks, Sea Knights, Sikorskys, Chinooks, Bell Jet Rangers, Hugheys, Hughes 500 and many other makes and models. The helos arrived from the Air Force, Marines, Navy, Air National Guard, Lifeflights from area hospitals inside and outside of the State as well as private individuals wearing jeans and T-shirts and any other means of transport available. The helicopters were loaded to the max with sick and injured evacuees. Many of the evacuees were rescued from roof tops and bridges, where they had been since the levees had broken, or from attics in homes engulfed by flood waters. The choppers were on the ground for no more then 2 minutes, just enough time to unload and take back off again to rescue more people. The patients were unloaded on litters and transported to us by Team litter bearers or on airport "tugs" which we see at airports through the airport gate window hauling food and baggage on a normal day.
Once in the terminal, our Deputy Commander Therese Rymer and her staff would lead the triage efforts and separate the patients into green, yellow, red, and black where they would be moved to the appropriate colored tents. The Green tent was for the walking wounded, yellow for delayed, and red for immediate treatment critical patients, according to triage protocols. Our black tag patients were transported to an "expectant " area and kept comfortable and warm, where they were secluded in an area of the terminal. These patients were attended to by our team Psychologist Ri Venuti and Chaplain Mark Reeves, as well as another nurse who was not with DMAT, but had volunteered her time to minister palliative care to these dying patients. We had numerous orders for Morphine to keep them comfortable so they would not suffer during their last hours on earth.
The Team Pharmacy Caches were supplied by FEMA and we were now on our 4th Pharmaceutical controlled substance cache as we had used up most of the pain meds as well as other ordered medications and were in desperate need of re-supply. Our Morphine supplies were dangerously low and all I could think of, was the suffering patients not having a sufficient amount of medication for their comfort and pain control.
As we were having major supply and communication problems, we were forced to think outside of the box as we had been trained to. Not only were we low on pain medications, but we were out of many of the chronic medications that people were on prior to Hurricane Katrina making landfall. Patients presented with co-morbidities which included hypertension, heart disease, diabetes, renal failure, and Psych issues as well as direct trauma and immersion due to the hurricane itself and its aftermath. To conserve our Pharmaceutical caches, Charlie Valencia, the Pharmacy Chief of Night Ops and I, the Pharmacy Chief of Day Ops, decided to dispense a 1 day supply of pain medication, a 3 day supply of chronic meds that patients were on prior to the disaster or were now ordered, and a full 7 to 10 day course of antibiotics. This was in the hopes that the patients would quickly be transported out to surrounding in and out of state hospitals. Unfortunately this was not always the case and we were often forced to refill their meds with our precious supply.
We made sure that we had supplied the triage area and tents with acute care and critical care drugs such as Benadryl, Lidocaine 1% with epi, Fluorescein strips, Amiodarone, Nitroglycerin and Atropine so that all levels of triaged medical care could be met. We circulated our formulary list to all of the Docs, arranged alphabetically and by therapeutic class. We encouraged them to only order from that list which was not always the case. Many of the patients had been on totally different medications then we had available and we were asked to make therapeutic substitutions by the Docs, as was needed, and based upon our professional judgment. These clinical judgments were made continuously, and our patients benefited from this total confidence that had been extended to us Pharmacists by the Team Physicians. Again we were running low on all needed meds, not just pain medications. The re-supply list we had submitted had still not been filled and was now several days old.
We were able to continue operation thanks to the USAF 375th EMEDS and 57th Medical Wing (Lackland Airforce Base), US Forest Service Southern Region Red Team, and private donations. We were able to get the much needed Morphine and Valium in less than 14 hours once ordered from the Air Force, even while we still struggled with the powers that be to allow us to use this life saving supply chain. I could still hear the words of DMAT CA-4 Team Commander Dr. Jake Jacoby saying "redundancy, redundancy, redundancy" and decided to call my Cardinal Health Contacts in San Diego in case FEMA could not fulfill our 3 day old re-supply requests. This was on a Saturday and I spoke with Lou Lawson from Cardinal Valencia at his home who redirected me to Tom Coltharp from Cardinal Atlanta. I could hear the sound of racquetball in the background which was a welcome sound of normalcy for me and I knew Tom was taking his own personal time out to assist me on this Saturday morning. He told me that whatever Cardinal could do to help, they would do, which has always been the case for our past deployments. Our sponsoring hospital, UCSD Medical Center, has an MOU with Cardinal and they had supplied our Pharmaceutical cache for our 2002 deployment to Guam. He offered to send their corporate jet from Ohio down to Atlanta, pick up our much needed critical meds including the controlled substances and fly them to New Orleans airport where we would take possession. We still needed to work out the controlled substance transfer protocols and I promised him I would get that in order. Not 10 minutes later I got a call from DEA agent Jim Crawford who told me not to worry about the paperwork that they would clear through whatever controlled substances we needed without all of the red tape paperwork. This was a welcome change for all that had occurred up to this point. Now all I needed to do was to get clearance to follow this supply chain. This request was denied. Apparently another drug supplier was being used and we were not allowed to go outside of that supply chain. I was extremely concerned and all I can say is "Thank God for the USAF. "
Having trained at Anniston, AL in 2002 on the Strategic National Stockpile from the CDC I felt confident that this Federal asset would arrive almost immediately as it had done during the WTC tragedy. Although I did see ventilators arrive after several days in the tell-tale SNS containers, medications were nowhere to be found. It was only until day four after our initial re-supply request that we got what I felt was some VMI (Vendor Managed Inventory) that was part of the Stockpile delivered to us, all but too late. Where was the SNS?? Was it ever requested by the Governor?? If so what happened to it? Certainly the magnitude of this disaster warranted its use.
All I can say, is that we did do a huge amount of good for the greatest number of patients, overcoming the most overwhelming of obstacles. The DMAT Pharmacists, my fellow DMAT CA-4 team members and the other DMAT teams, USAF personnel as well as the Federal Protective Service, US Air Marshals, Customs, and 82nd Airborne and any of the other "shooters" out there who "covered our 6" exhibited the utmost amount of integrity and professionalism that I have ever witnessed in my entire life. I would be honored to re-deploy with them in a heart beat anytime, anywhere and anyplace.
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