Memorial's evacuation triage categories

Memorial's evacuation triage categories were an improvised system for deciding which patients would leave first as staff tried to evacuate more than one hundred people from Memorial Medical Center and LifeCare Hospitals. The system sorted patients into three groups according to their apparent health and the assistance they would need; it also placed patients with do-not-resuscitate orders in the last group. Its practical urgency was inseparable from its ethical stakes: a temporary label on a patient's clothing became an order of access to rescue.

Formation in an emergency

By the morning the categories were used, hospital workers had difficulty locating enough official, color-coded triage armbands. They instead devised a simpler method for identifying patients as teams brought them downstairs. Nurses opened charts and reviewed diagnoses, using flashlights sparingly to conserve batteries. Anna Pou and other nurses assigned each patient a number, which staff wrote on paper with a Marks-A-Lot pen and taped over the patient's chest, or wrote directly on a hospital gown.

The categories emerged within a deteriorating hospital operation. Staff were moving patients from their rooms and assembling them downstairs while the building faced heat, sanitation problems, and limited capacity to continue treatment. Pou joined the coordination effort, and workers searched floors for cots and stretchers. Patients were carried or otherwise moved by makeshift teams that included medical staff and family members. The system was therefore not an abstract plan applied at a distance: it organized a mass movement through specific hospital spaces under severe constraints.

The three groups and their order

Patients categorized as 1 were in comparatively good health and able to sit up or walk. They were prioritized first. Roughly three dozen patients from Memorial Medical Center and LifeCare Hospitals were assigned this category and guided toward the emergency-room ramp, where they waited for the airboat evacuation plan to proceed. Gina Isbell, LifeCare's nursing director, and Karen Wynn, Memorial's nurse manager, oversaw their care there.

Patients categorized as 2 were sicker and expected to need more assistance. Perhaps seventy patients fell into this group during the day. Many were placed along a corridor leading toward an opening in the machine-room wall, a route to the parking garage and ultimately the helipad. The final group, categorized as 3, included patients doctors judged very ill, as well as those with do-not-resuscitate orders. Around a dozen and a half patients were placed in a corner of the second-floor lobby near a Hibernia Bank ATM and a planter.

The categories set priority, but did not mean that patients waiting to leave received no care. Staff continued basic attention: changing diapers, fanning patients, and offering sips of water to those able to drink. Yet once patients had been moved from their rooms on Wednesday, most other medical interventions were limited. The distinction between being cared for and receiving further medical treatment thus became part of the evacuation's practical reality. A neuroradiologist who encountered the numbered system regarded it as efficient but distasteful, registering the unease of turning a person's place in a rescue line into a numeral.

DNR status and the meaning of last

The decision to put DNR patients last had been made earlier by Memorial doctors as an exception to the usual idea of prioritizing the sickest patients and people dependent on machines. Four DNR patients were in the intensive care unit, including Helen Breckenridge and Jannie Burgess. A DNR order meant that a patient whose breathing or heartbeat stopped should not be resuscitated; it was not the same as a living will requesting that life-sustaining treatment be withheld in a terminal and irreversible condition. Such orders were usually made with the informed consent of the patient or a health-care proxy.

Richard Deichmann, Memorial's medical chairman, later explained that he believed DNR patients had to have a certified terminal or irreversible condition. On that understanding, he thought they had the least to lose if calamity struck and should go last. But the meaning of a DNR order did not itself establish that a patient was terminal, or that the patient should receive lower evacuation priority. The policy therefore rested not simply on a patient's documented instruction, but on a particular interpretation of what that instruction implied.

Burgess's presence among those placed last carried an additional historical resonance. She was an African American nurse who had worked for decades in New Orleans hospitals and nursing homes, including institutions where she could care for patients but could not receive care herself. She had been born shortly after Memorial opened as Southern Baptist Hospital in 1926, yet it took more than four decades before she could be a patient there. This history does not establish that race determined her triage category; it does underscore that a seemingly clinical classification operated within a hospital shaped by a long history of unequal access.

Uncertainty, consequences, and reassessment

Triage depends on judgments about condition and likely outcome, but those judgments are fallible. The account notes that experienced rescuers in a small study assigned widely different categories to the same patients, and that some patients who might have survived were judged unsalvageable. A patient's condition can also change, and resources may become available after an initial assessment. Once a number is assigned, however, the need to reassess can be easy to overlook. The risk of the Memorial system was not only that a judgment could be wrong, but that a label could make the judgment seem settled.

Pou and her colleagues had little, if any, training in triage systems and were not guided by a particular protocol. Pou later described the sorting as heart-wrenching and explained that the shift from prioritizing the sickest to sending them last reflected the doctors' sense that they could not save everyone. The language of doing the greatest good for the greatest number offered a consequentialist rationale, but it did not resolve which lives or outcomes counted as the greatest good, nor did it eliminate the need to judge individuals fairly.

The crisis also had a long aftermath for staff. Gina Isbell continued to have nightmares about patients and felt changed by the trauma of the days at Memorial, while Karen Wynn found that discussing the events in preparation for possible testimony could make them feel newly present. Their experiences do not show that the categories alone caused their distress; they reveal the human consequences of working within the wider evacuation crisis. Memorial's numbered groups remain significant as a record of an improvised decision under pressure—and as a warning that speed and order do not make uncertain judgments neutral or final.