Memorial Medical Center interrupted overnight Coast Guard evacuation

The interrupted overnight evacuation at Memorial Medical Center was a decisive break in the effort to rescue patients by air: while the United States Coast Guard was prepared to continue sending aircraft, hospital staff repeatedly deferred or turned away assistance. The decisions arose amid real dangers, exhaustion, darkness, and difficult patient transfers, but they also left critically ill patients waiting for rescue. By the end of the operation, four LifeCare patients had been flown to other hospitals; five ventilator-dependent patients had not made it out.

An offer deferred

Before eleven o’clock at night, a United States Coast Guard officer contacted the command center at Memorial Medical Center and offered to continue sending helicopters and boats. Sandra Cordray reported by email that as many as five helicopters could be deployed in a renewed effort to evacuate patients that evening. Anesthesiologist Paul Primeaux, the only clinical employee then in the command center, supported the plan. Without a radio, he ran through the garage and up to the helipad to alert the evacuation team.

The offer had already been declined before Primeaux arrived. A person had stumbled in the darkness and nearly fallen from the helipad, making the risks of night operations immediate rather than theoretical. Primeaux understood the danger: earlier, he had tested the old, flat fencing around the helipad and worried that it might not support his weight. Even so, the decision to turn away the rescuers frustrated him. The episode set the terms of the night: the potential danger of continuing had to be weighed against the danger of leaving patients in place.

Around eleven, a Coast Guard Jayhawk helicopter arrived at Memorial Medical Center. The aircraft had been directed there by a C-130 relaying search-and-rescue requests, although the Acadian coordinator believed he had signaled it. The crew was prepared to begin evacuating the remaining patients. Someone on the helipad instead told them that no patients still needed to leave and that they should return after daylight. The helicopter then flew to Tulane Hospital, carrying the Acadian coordinator and roughly a thousand pounds of medical equipment removed from private helicopters earlier in the day to make room for patients.

The decision to wait

The possibility of resuming rescue did not disappear when the first helicopter left. Cell phones in the command center continued ringing, and United States Coast Guard personnel remained committed to overnight operations, particularly after learning that seven LifeCare patients depended on ventilators, water was rising, and power might fail within hours. A doctor sent a security guard to wake Richard Deichmann and ask what the Coast Guard should be told about sending additional aircraft for the LifeCare patients. Deichmann said to send them in the morning. He considered reopening the helipad too dangerous and believed the staff needed rest.

Susan Mulderick, the incident commander for Memorial Medical Center, discussed the plan with Diane Robichaux, LifeCare’s incident commander. With the elevators out of service, Robichaux expected that her staff would need additional help carrying the most critically ill patients downstairs. Mulderick said that the men she could provide had gone to bed, and Robichaux agreed to wait until daybreak. Waiting would also allow LifeCare to send ambulances and transfer patients to other LifeCare hospitals. That offered a more orderly handoff while regional hospitals were crowded, and kept the patients within LifeCare’s system.

At the United States Coast Guard emergency command center in Alexandria, Shelley Decker learned that at least three helicopters had already gone to Memorial Medical Center and been waved away. She pressed for them to return. Michael Richard, speaking by phone with a nurse leader on the helipad, understood that the nurse’s gestures might be mistaken for signals to land when she was trying to turn aircraft away. Decker’s intervention helped bring aircraft back, but the conflicting messages from inside the hospital continued to complicate the rescue.

A rescue resumes, then stops

Pilots returned as instructed and maneuvered the helicopter onto the helipad at night. Crew members were again told that there were no critically ill patients to rescue, although staff and others wanted to leave and were becoming difficult to manage. A flight-team member sought clarification over the radio. Information from inside the hospital confirmed that patients were still there awaiting evacuation.

From the helipad, Mulderick and a flight mechanic saw a patient being carried up the metal stairs in barely any light. Mulderick thought it was extremely dangerous for untrained staff to move patients this way. She allowed the crew to take that patient but told them not to return to Memorial Medical Center. When a doctor feared the patient would otherwise be left unattended on the helipad, the team arranged to fly the woman to the hurricane-damaged Coast Guard New Orleans Air Station and transfer her to another aircraft. The helicopter left at 5:15 a.m. with the patient and a LifeCare nurse.

Mulderick’s decision to end the airlift had not reached every crew. A fresh Jayhawk team, which had departed a Coast Guard air training station in Mobile at 3:30 a.m., also received a request for help. The crew agreed to transport two ventilator patients at once. During the flight to a hospital in Lafayette, more than an hour away, the rescue swimmer manually ventilated the patients and monitored their vital signs. The rescue continued even as the hospital-side decision to stop the airlift had already been communicated elsewhere.

Patients left behind

By before six in the morning, Decker had been told that operations would stop for the time being and might resume at nine. Memorial nurses explained that the building was dark, that patients were being moved by hand on the stairs, and that a nurse had to keep ventilating them manually. Decker had assumed that emergency lighting was available. From her illuminated command center, with electricity, running water, and working phone lines, she struggled to picture the conditions described by the nurses. The contrast made the distance between rescue capacity and the hospital’s ability to prepare patients for evacuation especially stark: aircraft could be sent, but patients still had to reach the helipad.

The nurses also told Decker that the remaining ventilator patients were DNR and that operations had to pause, though not all of those patients had DNR orders. A nurse assured her that patients would continue to receive manual ventilation. The reassurance did not resolve the central obstacle: the Coast Guard could provide aircraft, but the hospital’s staff could not safely move every patient to them under the conditions then prevailing.

Four LifeCare patients who left on Coast Guard helicopters were successfully transferred to other hospitals. The remaining five ventilator-dependent patients did not get out of Memorial Medical Center. One patient died while being carried down the staircase. A fifty-one-year-old woman in a deep coma who had a DNR order remained on the seventh floor. Staff members said that patients with DNR orders could not go. The result exposes the limits of describing the night simply as a shortage of rescue resources: aircraft repeatedly appeared or were available, while judgments about safety, staffing, timing, and DNR status determined whether patients could reach them.