Emory Report
September 19, 2005
Volume 58, Number 4


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September 19, 2005
Going Home


When Hurricane Katrina made landfall east of New Orleans on Monday, Aug. 29, Ricardo Martinez was glued to his television. A native of the city and a graduate of the Louisiana State University School of Medicine, Martinez’ ties are strong to the area. Not only do several family members live in New Orleans, but he travels to the state frequently for work. An assistant professor of emergency medicine in the School of Medicine, he also serves as executive vice president for medical affairs with the Schumacher Group, a Louisiana-based emergency management company, which after the hurricane was working to evacuate several hospitals in the New Orleans area.

The storm itself knocked out communications to the area, so Martinez lost contact with his family. When the levees protecting the city from the waters of Lake Pontchartrain broke on Tuesday, Aug. 30, flooding 80 percent of New Orleans, Martinez still hadn’t spoken to any of his family members. Cell phones were down, and without electricity, e-mails were an impossibility. He didn’t know if they evacuated.

Martinez finally got in touch with his family on Saturday, Sept. 3. His brother was in a hotel in Texas. He tracked down his mother near Lafayette, La.

“My little brother is staying with my mother-in-law, my wife’s family,” Martinez said. “My mom is staying at a friend of my brother’s wife’s friend.” He paused to let the flow chart of that situation sink in. His family’s homes in New Orleans were destroyed.

“That’s how things work,” he continued. “Another friend of mine in Baton Rouge had 15 people in his house.”

The day Martinez finally spoke to his family was the same day he stepped off a helicopter at New Orleans’ Louis Armstrong International Airport to treat evacuees. He had flown to Lafayette the previous day to coordinate the hospital evacuations.

In addition to his background in emergency medicine, Martinez’ skills are well-tuned to the post-Katrina needs of the New Orleans area. He is an expert in logistics and transportation. From 1994–99 he served as administrator of the National Highway Traffic Safety Administration (NHTSA). Martinez knows how to get things where they need to go.

He helps set up air ambulance companies (if there was anything New Orleans needed, it was air ambulances). Martinez also works with the National Football League as part of an advance team for the Super Bowl. His overarching concern? Emergancy preparedness and response.

All of that prepared him for the post-Katrina chaos spread throughout the airport—but what Martinez saw was still a shock.

Helicopters carrying evacuees from the city would touch down every 60 to 90 seconds, then take off just as quickly. Patients who could get out under their own power, would. Those who couldn’t were loaded onto baggage carts, which would carry them to the terminal.

The baggage claim area was full of patients, many of them from nursing homes who had not had standard care for days. They were in danger of becoming critically ill. Upstairs in the airport concourses, a MASH unit had been set up with three triage areas: green, yellow and red. The red patients were the sickest and were being flown out by helicopter to various hospitals throughout Louisiana and eventually other states.

Individual physicians, including Martinez, saw about 50 patients each (grouped off by yellow tape), although there were thousands of evacuees being processed. Before Martinez saw his group, they had received little care. Since they appeared to be stable, they got shuffled to what was essentially a large waiting room. The acute patients had beds, but few stayed in them long.

“It was a very humbling experience,” said Martinez, who spent about seven hours at the airport. “You knew the best thing to do was to get those people the hell out of there.”

Interestingly, perhaps morbidly, Martinez had visited New Orleans the week before the storm hit. He attended a three-day medical meeting at the Ritz-Carlton hotel downtown. During the trip, he spent about seven hours at the airport waiting for flights and rental cars and casually wandering the terminal. It was a memory that flashed back on his return trip.

“It was surreal in many ways, he said. “It was hot, we were running ragged, moving patients, and suddenly I realized I was in the same spot I had been before. But it had been so changed by the numbers of people and the temporary facilities that I didn’t even realize I was by the Delta counter.”

Martinez explored other parts of the airport as well. It was renamed for native son Louis Armstrong in 2001, but Martinez frequently refers to it as “Moisant,” a name that went away in 1960. It’s a subtle sign of how deep his ties are to his hometown.

“There was this area of people who were essentially healthy; they were coming in on buses,” he said. “I watched people stand in line for an hour-and-a-half to get a bologna sandwich. They were as calm and as nice as could be. It was amazing.” Then he paused briefly.

“But it was very sad for me, having been from New Orleans.”

Martinez ran into several old friends and colleagues. He encountered specialists from LSU who were coordinating the most basic care. He also briefly spoke to one of his former fellows from his days on the faculty at Stanford University.

U.S. Sen. Bill Frist, Senate majority leader and a cardiologist by training, traveled to New Orleans to lend his medical expertise without a lot of fanfare (minimal news coverage and just one aide, Martinez said). Martinez said, when he served in the Clinton administration, he and Frist would engage in such medically specific talk at meetings that the latter’s fellow senators would get completely lost. Their conversation in New Orleans was a lot less technical.

Frist asked Martinez what he thought of the situation. “I’m afraid this is as good as it’s going to get,” Martinez replied.

Martinez returned to Lafayette that evening on a fixed-wing aircraft that connected in Shreveport, La. The next day, he drove down to Baton Rouge. He not only worked on the LSU campus, where patients were being processed at the school’s athletic facilities, but he also traveled to an extension of the LSU hospital system—set up at an empty K-Mart.

“It was set up to take special needs patients—nursing home patients, dialysis, pregnant women,” Martinez said. The 1,000 bed facility (“bed” is relative term; some patients slept on lounge chairs) was a full-service operation that had been constructed in two days. Despite the crudeness of the surroundings, it had areas for psychological and social services, a full pharmacy and a nursery. Still, as with everywhere else, communications was a problem.

“The things that worked most reliably were BlackBerrys and phone text messages,” Martinez said. “I was looking for my brother in Baton Rouge and he was at the LSU Assembly Center. They couldn’t coordinate transfer, so he text messaged me, then I passed along that message.”

On Monday, Martinez was back in Lafayette, where he stayed through Thursday, Sept. 8. He spent the remainder of his time helping manage the air ambulance and emergency management groups based there.

“We take great pride in that we leave a city better than we found it,” Martinez said about his work with the NFL advance team, which begins its work with the host city a year before the big game. It’s a thought that easily can be applied to his most recent trip to his hometown.

For that to happen, Martinez said, there needs to be more of a coordinated response to disaster. He disagrees with the view that immediate fire and police response is enough; immediate medical care must also be part of the solution.

“Response is the first thing, but providing the care and absorbing these people is just as important,” he said. “We really have to expand our vision to see the totality of what a real response means. Response goes all the way to recovery; you don’t just show up. Recovery is going to mean a lot of things—water, electricity. From a health care perspective, this just overwhelmed the system and will for months.

“It would be a tragedy to not take advantage of what we have learned and make a difference,” Martinez continued. “Somebody told me at the airport that supposedly we learned our lessons in Hurricane Andrew. Nice try—didn’t work. Now there is much more of a political focus on it; And I think it’s raised a lot of appropriate questions.”