New Orleans City Hall became an emergency operations center during Hurricane Katrina, but its role was shaped as much by the crisis’s limits as by its responsibilities. Surrounded by several feet of floodwater, the municipal building housed staff trying to understand the condition of hospitals and nursing homes and find help for people trapped inside them. From desks in the building, Cynthia Matherne pressed for rescue even as communication failures and unclear authority left the wider response fragmented.

An emergency center in an isolated city

By Wednesday morning, City Hall had been transformed into a crowded operations center. Phones rang as people in uniforms and civilian clothes moved between desks and meetings. The building was itself encircled by floodwater, while the city’s hospitals were increasingly cut off from ordinary support. Tenet Healthcare Corporation employees in Dallas had been unable to reach staff at Memorial Medical Center and another hospital in the flood zone; seeking information, they contacted officials who might know what was happening on the ground.

The urgency had been foreseeable. New Orleans officials had conducted the Hurricane Pam emergency exercise, whose scenario asked how to respond when hospitals became islands and how to decide which patients could be moved first. But Matherne knew that no plan actually set out how the city’s hospitals should be evacuated after a hurricane, or which agency was responsible for doing so. The exercise had assumed that rescue resources might be occupied for days with people stranded on rooftops and trees, leaving hospitals to sustain themselves. In the flood, those planning questions became immediate logistical problems.

Matherne’s work from City Hall

Matherne, an experienced hospital emergency manager with military experience, was responsible for learning what was happening at regional hospitals and nursing homes and relaying that information to emergency officials. Her regular position was as a bioterrorism-preparedness coordinator for the local hospital association. The program had been established after the September 11 attacks and anthrax mailings, then expanded only recently to include natural disasters—a belated recognition that such emergencies were more frequent than bioterrorism attacks.

When Matherne learned that at least two hospitals had lost power, she sought out liaisons from the United States Coast Guard and the Guard and asked them to rescue the hospitals’ trapped occupants. One serviceman replied that the people inside were in a safe building and had supplies. Matherne challenged that assessment: without electricity, she argued, patients could not be cared for. Her appeal brought into view the difference between a building’s apparent safety and a hospital’s ability to keep its patients alive.

By Wednesday morning, Matherne had concluded that private resources offered the best hope of rapidly evacuating private hospitals. When she conveyed that view to Tenet regional senior vice president Bob Smith, he was incredulous: the company had no experience conducting rescues, no helicopters, and no disaster plan prepared before the storm. Its corporate jet could not land on a hospital roof. City Hall was thus a place where needs and possible resources were being matched, but it could not supply capabilities that neither public agencies nor private operators had arranged in advance.

Coordination without a reliable command system

The emergency center’s work took place amid severe communications and command problems. The local Coast Guard air station had been damaged; its radio antenna was down, its generators repeatedly failed and temporarily recovered, and fixed telephone lines were out. Commanders could reach their superiors only intermittently by satellite and cell phone. With no practical way to impose a rigid command structure, rescue crews had not divided the city into a systematic grid. Helicopter units coordinated with one another in flight but often set their own priorities, rescuing people as they encountered them.

Those conditions limited what information City Hall could gather and what its requests could accomplish. Matherne could identify the danger to hospitals and appeal to agencies and companies, but the broader response lacked a clear assignment of responsibility and dependable communications. City Hall’s presence as an operations center therefore did not amount to unified control of the rescues; it was a pressured point of coordination within a system whose parts were struggling to communicate and act together.

Significance within the wider evacuation failure

The City Hall episode belongs to a wider pattern of preventable vulnerability. New Orleans’s mandatory evacuation left many residents without cars dependent on transportation plans that had too few drivers, while ambulances were caught in traffic and some began taking patients to the Superdome rather than out of the city. In retrospect, the deaths and suffering that followed had many causes, including delayed evacuation, inadequate transport, uncoordinated rescue efforts, poor communications, and hospitals and nursing homes without sufficiently robust backup power and water systems.

City Hall’s flood-surrounded desks joined abstract preparedness questions to urgent decisions about real patients. The exercises had raised the problem of isolated hospitals, but the city entered the storm without a settled evacuation plan or a clear rescue chain of command. Matherne’s appeals made the hospitals’ needs visible; the improvised, dispersed response around them showed how little visibility and coordination alone could do without reliable communications, assigned authority, and resources ready for the conditions they had anticipated.