Phased evacuation at Memorial Medical Center during Hurricane Katrina was not a single, orderly removal of patients but a shifting effort conducted under severe transport and communications constraints. As the city’s evacuation exposed the lack of ways to move many people without cars, the hospital’s own patient movement narrowed from broad plans for rescue to improvised categories and limited departures. The sequence left the sickest patients especially vulnerable to delay.

Citywide evacuation and the hospital’s remaining population

At around ten in the morning, New Orleans mayor Ray Nagin ordered an immediate mandatory evacuation. The order came after delays over logistical and legal questions, while residents who could leave were already caught in traffic. People without cars were directed to take shuttles to the New Orleans Superdome, designated as a last-resort shelter. Nagin urged people with medical conditions, including those needing dialysis, to go there, but did not specify what assistance they could expect. Hospitals, by contrast, were exempted from the order so they could remain available to people injured in the storm.

The gap between that citywide plan and the practical ability to move people quickly was already visible. Acadian dispatchers were overwhelmed by requests to transport patients from hospitals, nursing homes, and homes. Many ambulances were stuck on the interstate, and some of the company’s vehicles began taking patients to the New Orleans Superdome rather than trying to carry them out of the city. The difficulty was not confined to Memorial Medical Center: across New Orleans, patients needing transport competed for scarce vehicles as roads clogged.

By the time the hospital’s patient count had fallen from 187 to about 130, a large community of staff and relatives remained inside: 460 Memorial employees, 447 family members, and 52 LifeCare employees. All 52 LifeCare patients were still on the seventh floor, including seven who depended on ventilators. The contrast between a reduced census and the substantial number of people still in the building shows why the hospital’s evacuation could not be treated as a simple matter of moving a few remaining patients.

A hospital operating with failing systems

On Wednesday morning, the hospital’s environment and basic services had deteriorated. Water no longer flowed from the taps, toilets were backed up, and the corridors were dark. Phones, televisions, computers, and overhead pagers were not working, so information had to be carried by word of mouth, including up and down the staircases. These failures made it harder to coordinate a movement that depended on staff knowing which patients were ready, where they should gather, and when transportation would arrive.

A representative of the state Department of Health and Hospitals arrived and told incident commander Susan Mulderick to prepare to clear the building by the end of the day. At about seven in the morning, the incident command team agreed to consolidate patients and resources near exits on the first and second floors. Staff initially sought the hospital’s emergency color-coded armbands: green for patients able to walk, yellow for those needing assistance, red for those wholly dependent on care from others, and black for patients with DNR orders. The armbands were intended to make patients’ needs legible during a mass movement, but the hospital had difficulty finding enough of them.

Triage changes as evacuation proceeds

That morning, staff adopted a numerical system for the more than one hundred remaining patients from Memorial Medical Center and LifeCare. Patients in comparatively good health who could sit up or walk were designated 1’s and given first priority. Patients needing more assistance were 2’s. Patients judged very ill, along with those who had DNR orders, were placed in the final group, the 3’s. The system turned differences in mobility and medical condition into an order of departure; it also meant that DNR status placed a patient among those scheduled to leave last.

Staff and relatives carried or wheeled patients toward the lower floors while boats were expected to ferry people to dry ground. Anna Pou helped coordinate the movement, and staff searched floor by floor for cots and stretchers to bring to the second-floor lobby. The effort involved makeshift teams rather than a fully functioning communications network: patients had to be gathered, classified, and moved through the building while rescue plans remained dependent on boats and outside coordination.

The plan shifted again as the day continued. Instead of loading the boats with the sickest patients waiting for evacuation, staff began sending only those relatively few patients well enough to be discharged. Several doctors moved to the emergency-room ramp to oversee loading, and hospital employees and family members were allowed to leave alongside patients. The line for evacuation reached from the ramp through the emergency room and into reception. The distinction between moving patients who needed continuing care and allowing comparatively mobile people to depart became increasingly consequential as the operation continued.

Interrupted rescue and the final effort

The interruption in helicopter evacuation sharpened the uncertainty. Around eleven p.m., a Coast Guard Jayhawk arrived at Memorial Medical Center with a mission to begin evacuating the remaining patients. Someone on the helipad said no patients still needed to leave and suggested the crew return after daylight. The helicopter was instead sent to Tulane Hospital with an Acadian coordinator and medical equipment, leaving Memorial without patients aboard. At that point, the hospital still held its LifeCare patients on the seventh floor, including those dependent on ventilators.

Early on Thursday, September 1, doctors discussed the failure to continue the helicopter rescue during the night and the small number of patients who had departed since. Rather than wait for the scheduled morning meeting, surgery chief John Walsh left after first light with an anesthesiologist on the plant-operations director’s fishing boat to help organize a more concerted rescue. Another anesthesiologist sought Pou and Roy Culotta to ask them to reassess the remaining patients. Their stated message was that everyone would be getting out, a commitment set against the previous day’s delays and the uncertain arrival of further transport.

The evacuation did not get every patient out. Four LifeCare patients who left on Coast Guard helicopters were transferred to other hospitals, but five remaining ventilator-dependent patients did not make it out of Memorial Medical Center. One patient died while being carried down a staircase; a 51-year-old woman in a deep coma with a DNR order remained on the seventh floor after staff said that patients with DNR orders could not go. These outcomes give the shifting triage system its human consequence: the patients most dependent on assistance were not simply slower to move but remained exposed to an evacuation whose priorities and means kept changing.

Wider significance

The evacuation unfolded within a citywide failure to match evacuation orders with transportation. Many residents had no way to leave independently; ambulances were immobilized in traffic, and hospital and nursing-home patients depended on plans that could not reliably move them to safety. At Memorial Medical Center, the failure of basic services and communications compounded that larger shortage. The hospital’s categories offered a practical way to sort people, but the changing priorities and interrupted rescue meant that classification could not guarantee a route out.

The episode also sits within a broader pattern of responsibility failures identified after the storm: delayed evacuation, too few buses and drivers, uncoordinated rescue efforts, poor communications, and facilities without backup systems robust enough for a prolonged emergency. Those conditions did not affect everyone equally. People able to travel independently had a different prospect from patients who needed ambulances, ventilators, or continuous assistance. Memorial Medical Center’s phased evacuation thus records both an improvised attempt to move a crowded hospital and the consequences of a disaster response unable to secure timely passage for everyone.