Living in Louisiana is great: the food, the people, the vibrant culture. But there are six months out of the year that give many of us pause. Hurricane season can lead to unpredictable events that present unique challenges for physicians. Thankfully, anesthesiologists are notorious planners. In times of impending disaster, hospitals must have emergency operation plans and activate an incident command center. Planning is essential, but each storm brings unique challenges.

It was a rough year for all in 2020; no one will argue with that statement. For southwest Louisiana, and in particular the city of Lake Charles, Mother Nature brought “a little something extra,” or “lagniappe” (LAN-yap), as we say in Louisiana. However, the lagniappe was neither little nor welcomed. Two major storms, Hurricane Laura on August 27, 2020, and Hurricane Delta on October 9, 2020, delivered a devastating blow to the area.

Category 4 Hurricane Laura became the strongest tropical cyclone, in terms of wind speed, on record to hit the state, with sustained winds of 154 mph, leveling much of southwest Louisiana. The effects on every level of infrastructure were devastating. The local economy and power grid were decimated, water treatment plants made inoperable, and roadways rendered impassable with downed trees, powerlines, and debris. Most homes were unlivable from flood or major structural damage, wind shearing, and toppled trees. Six weeks later, Category 2 Hurricane Delta (100 mph) made another direct hit on the already suffering city.

I practice in a two-campus community-based hospital system composed of a 314-bed acute care facility as well as a satellite inpatient women’s specialty center. Our disaster preparedness plan states that the on-call physician will stay in-house until deemed safe for a relief team to take over. As it turns out, I was on call at our women’s campus when Hurricane Laura was projected to make landfall. Worst-case scenario preparedness is a common practice of physician anesthesiologists and is rooted in the meaning of the seal of ASA – the stars of our logo represent the constant and eternal vigilance of the physician anesthesiologist. Preparing for the worst-case scenario is core to every physician anesthesiologist’s being. Hospital administration did not originally plan to evacuate the facility, so I rallied other physician leaders and implored the hospital to consider the request. We were granted immediate assistance and evacuated the entire campus, including 19 NICU babies, to our larger acute care facility. We completed our evacuation just as tropical storm-force winds reached us.

After hours of driving winds, rain, and flying debris, by morning all was calm. Both campuses suffered major structural damage in addition to rain and flood water intrusion. Initially we had back-up power and water, but these supplies and resources were short-lived. Electrical grid failure coupled with damage to sewer and water treatment facilities gave way to third-world conditions. Soon our water-cooled generators failed and we were forced to evacuate yet again, this time out of the city.

One of the challenges during a hurricane is communication. Departmental communication was conducted via group messaging and our emergency alert system. Locating staff can be extremely difficult, and even when you do, they may be just trying to take care of their daily needs. It is very difficult to restart hospital services after a storm, but the community requires our services. In our case, it took nearly four weeks to reopen emergency, inpatient, and surgical services, albeit in limited capacity.

Fast forward one year to hurricane season 2021, and roughly 210 miles east sits New Orleans. Hurricane Katrina, which many in the area still use to demarcate different time periods in life, taught us many lessons. We now have a more robust levee system protecting the city from dreaded storm surge, but the effects of a hurricane can be much more than that. Infrastructure such as power, water, and sewage, necessities we ordinarily take for granted, can be devastated in an instant.

Each academic year at Tulane School of Medicine (SOM), hurricane planning begins. Activation teams are identified from programs that are deemed essential. To minimize disruptions in residency training, our emergency operation plan describes several levels of impending storm preparedness, and our facility and our departments speak the same language regarding preparation. The teams, chosen at the outset of each academic year, are voluntary and have qualifications of being in post-graduate year two or above. Teams are chosen thoughtfully and with consideration for family and health circumstances, as relief can be protracted. Residents and faculty not on storm coverage are encouraged to follow local officials regarding the need for evacuation.

On August 29, 2021, the 16th anniversary of Katrina, Ida made landfall as a powerful Category 4 storm. New Orleans did not call for a mandatory evacuation due to the rapid storm intensification, and our storm designation “Code Grey” was activated. Not only was I on the storm team, but as the residency program director I was committed to ensuring our off-duty residents were evacuated to safety. No matter what you see on television, “riding out” a storm is not advisable, and many of our residents had never experienced a major storm. As much as Katrina was a water event, Ida was a wind catastrophe with sustained winds reported at 150 mph at landfall. As was Dr. Nester’s experience, infrastructure was dramatically impacted. We learned that the entire power grid was nonfunctional as the power conduits traversing the Mississippi River into New Orleans had fallen into the river.

The Capitol One building, which is the tallest building in the Lake Charles area and a local landmark, suffered major structural damage. Photo courtesy of Kyle P. Nester, MD, FASA.

Surprisingly, both internal and external communication remained available. Despite long estimates for the return of power, hospitals were prioritized, and Tulane was online within a week. Zoom calls with SOM leadership were a daily occurrence. Necessities such as food, water, habitable shelter, and ability to obtain fuel all came to light as priorities for not only the current hospital team but those who stayed in the area and those returning to provide relief. Resources were made available with joint efforts from the hospital and the school of medicine.

Not all the Tulane facilities were spared. We were informed by the local government that our satellite facility, Tulane Lakeside Hospital, was without power and they had negligible water pressure and minimal drinking water. That facility successfully relocated all patients and remained closed for nearly a month while repairs were performed.

Both scenarios utilized the skills that we have honed as anesthesiologists. Planning, preparation, team utilization, and grace under fire become significant assets to our facilities. Building and maintaining plans for a successful and safe storm activation are critical to the safety of our patients, staff, and community. Unfortunately, one of the grim realizations after a storm, when relief finally comes to take over, is that surviving the storm is just the beginning.