Data and Information Source

This field report is based upon debriefing sessions and after-action reports conducted post-storm and discusses logistical pitfalls and the subsequent lessons drawn during a real-time hurricane disaster response. Residency debriefing sessions occurred between chief residents and residency classes in the form of a standard residency forum. Additionally, the LSU EM post-disaster committee, composed of residents, academic faculty, and ancillary personnel, convened a separate meeting with hospital administrative-level leadership for full examination. These sessions were solely for the purpose of generating feedback regarding the efficacy of the program’s response to the many challenges posed by Hurricane Ida. The information obtained was then used by the chief residents to develop a more formalized Code Grey process, as well as future orientation and education materials for residents.

Observations

Each academic year, LSU EM residents receive correspondence from the chief resident presiding over development of the Code Grey disaster response team. At that time, important information is disseminated to the program regarding essential processes to successfully navigate a hurricane disaster response. In the days immediately preceding Hurricane Ida, daily contact chains from hospital administration, chief residents, and emergency department (ED) leadership were established to ensure the most up-to-date information was available to all residents.

On August 28, 2021, the decision was made to activate the University Medical Center New Orleans (UMCNO)’s hospital-wide hurricane disaster response, the morning of anticipated Ida landfall, with subsequent activation of the program-specific Code Grey protocols at 7:00am. This included an in-house lock-down of faculty, residents, and auxiliary staff until relief teams were dispatched post-storm. However, residents scheduled to work on August 28th expressed concern about their ability to evacuate post-shift, prior to the hurricane reaching Orleans Parish. As such, the decision was made to activate Code Grey on the night of August 28, allowing the residency’s disaster response evening team to relieve house staff 12-hours earlier than initiation of the hospital’s official lock-down. Post-hurricane debriefing indicated that having the activation staff in place at a minimum of 24-hours prior to hospital lock-down would have been preferable, as this would have allowed for ample opportunity for resident evacuation and preparation.

On initiation of Code Grey, all residents not on the activation team were excused from clinical duties and advised to either evacuate the area or shelter in place, as a “mandatory” evacuation order for the New Orleans area was not in effect. As such, highway and airport closures in the adjacent gulf region complicated coordination and initiation of the post-storm relief considering many residents who were members of the recovery team evacuated to locations >500 miles or >48 hours outside of New Orleans. Residency leadership, many of whom were also working as members of the ED activation team, quickly had to locate residents near enough and who could return safely to be part of the immediate post-storm recovery team.

Relief team ED staffing was challenging due to issues with communication, evacuation locations, and city-wide safety concerns. Approximately two days preceding Ida landfall, an online spreadsheet was sent to all ED residents requiring evacuation location with address, phone number, and miscellaneous needs regarding evacuation. This allowed residents easy access to the most current location data of program members and allowed Code Grey leadership to use the document to verify the safety of evacuated residents. Correspondence favored the activation team in the days leading up to the storm. Few organized discussions occurred with residents assigned to the recovery team regarding evacuation location, comfort with and plan for returning safely, and post-storm living conditions. Subsequently, many residents’ evacuation locations led to difficulties getting people back into town. New Orleans’ main airport, Louis Armstrong International, was shut down in the week following the storm, making it difficult for residents to report for relief duty without navigating multiple logistical barriers and incurring significant personal monetary costs.

Additionally, the eye of Hurricane Ida passed due northwest of New Orleans, resulting in the prolonged closure of I-10, the major highway leading from both Baton Rouge, Louisiana and Houston, Texas (USA). As the next closest major metropolitan areas within driving distance of New Orleans, both cities were logical evacuation sites for residents. Closures of I-10 thus created additional delays in recalling multiple relief team members. To compound this issue, many non-activation residents chose to carpool on evacuation, for both camaraderie and to consolidate resources. This created inevitable delays and logistical challenges when recalling specific individuals. The final major hurdle for post-storm staffing, from a man-power perspective, pertained to the on-going infrastructural issues in the city, especially from a safety and housing perspective. City-wide extended power outages, impassable streets, and wide-spread residential damage forced city officials to issue “stay-away” warnings to evacuated residents desiring to return soon after the storm threat had dissipated. The question of “How safe is safe enough?” to insist that people return, especially considering conflicting local government warnings, led to internal debates among hospital and program administration regarding an appropriate timeline to recall residents in a safe and organized manner.

Summer in New Orleans is notoriously hot and humid, posing actual health risks to those without air conditioning. Many residents expressed concerns about returning to areas without power and/or hurricane-related damage. A significant amount of time was spent securing safe lodging for relief members returning to the city, through hospital call rooms, individuals with generators allowing residents to stay with them, and eventually with program and Federal Emergency Management Agency (FEMA; Washington, DC USA)-sponsored hotel rooms. These safety concerns (and the resources needed to address them), in conjunction with issues of communication, disparities in evacuation plans, and storm-driven geographical hurdles, made putting together a practical recovery team difficult.