Survival Mode

Survival Mode was the emergency operating designation adopted at Memorial Medical Center during Hurricane Katrina when staff learned that a canal had breached and water might be approaching the hospital. It converted the hospital’s immediate priorities from routine operations to staying in place under threat. The directive imposed practical controls on staff, services, and supplies, but it did not resolve a deeper problem: critical parts of the hospital’s emergency infrastructure were exposed to flooding, and its backup power ultimately failed.

Declaration and Immediate Context

The shift was announced at a command-team meeting after an Acadian ambulance worker at the hospital confirmed the canal breach with dispatchers. Staff had expected that the returning “B” team might take over so others could go home; instead, the breach raised the possibility that the hospital would have to shelter its workforce and patients for an extended period. The designation was unofficial, but the command team reinforced it in a memo: “Incident Command has declared Survival Mode for Memorial Medical Center.”

The news arrived amid signs of strain outside the hospital as well as within it. New Orleans had ordered an evacuation, but many residents lacked cars or other ways to leave, traffic was already jammed, and the city’s transport plans had serious gaps. Acadian dispatchers were overwhelmed by requests from hospitals, nursing homes, and homes; many ambulances were stuck on the interstate, and some began taking patients to the New Orleans Superdome rather than out of the city. At Memorial, meanwhile, conditions initially appeared manageable: workers cleared debris and patched the roof, and kitchen employees prepared food for patients, staff, and the people sheltering in the building. That appearance of ordinary function coexisted with the expectation that flooding could come.

Orders and Hospital Operations

Survival Mode required staff and physicians to remain at the hospital, and families were advised to stay as well. The hospital anticipated flooding and suspended elective surgery and imaging, including MRI, PET, and CT scans. Medically stable patients were to be discharged, even when they had no clear destination or means of transportation; some were placed in wheelchairs in the lobby to wait. The directive thus treated remaining inside as a serious risk while also leaving some patients with no easy way to leave.

The command team also required each department to report by noon with the names of employees and family members present and an inventory of medicines, supplies, equipment, and cell phones. Landline service was intermittent, so accounting for mobile phones formed part of the effort to understand what communication capacity remained. The head pharmacist was still trying to arrange a delivery to replenish dwindling medication supplies. These instructions made Survival Mode a system for taking stock as much as a change in clinical activity: the hospital needed to know who and what it had available if outside assistance became difficult to obtain.

Dialysis exposed the limits of those resources. The city’s clinics had closed, and patients in renal failure were arriving at the hospital, including people transferred from Chalmette. Only one dialysis nurse was available for patients at Memorial and LifeCare. A LifeCare nursing director and another nurse volunteered, then helped tutor a kidney specialist who was experienced in ordering dialysis but not performing it. The procedure required water, yet the municipal supply was reportedly contaminated. Because patients would die without dialysis and it was unclear how soon they could be moved, staff filtered water and hoped it would be safe enough; elsewhere, employees formed an assembly line to boil water in a microwave for other uses. Survival Mode therefore depended on improvisation around basic utilities, not merely on a revised schedule or a reduced set of hospital services.

A Known Vulnerability in the Power System

The danger to Memorial’s operations had been documented before the storm. After Hurricane Ivan narrowly missed New Orleans in 2004, plant operations director Eric Yancovich studied storm-surge models with the US Army Corps of Engineers. Those models indicated that a major hurricane could bring twelve to fifteen feet of water around Memorial, which sat three feet below sea level. Yancovich’s hand-drawn elevation calculations showed that less than four feet of flooding on Magnolia Street could send water over the loading dock. Although the generators themselves were on the second floor, parts of the emergency power distribution system—including transfer switches—were in the basement or only inches to a few feet above ground level.

Yancovich warned that relatively little water could disable most of the medical center and predicted that patients might have to be moved to the Clara Wing, whose electrical circuitry he believed was better protected. Memorial had taken some protective measures, including adding floodgates and raising the vent for its underground diesel tanks. But Yancovich also recommended elevating emergency power transfer switches and the pumps supplying medical air and vacuum suction. A partial bid for electrical work exceeded a quarter of a million dollars; citing a lack of capital, he expected that the work would not be approved at the time. The weakness Survival Mode had to contend with was therefore not simply an unforeseen equipment problem: the hospital had identified the exposure, while substantial proposed work remained unfunded.

The Collapse of Backup Power

Memorial’s three 750-kilowatt generators had already been running for two days when their problems multiplied. They had not been built for prolonged operation, even though the hospital’s disaster plans expected them to support the building for at least three days. The staff on site had no generator mechanic. When an engine overheated, workers added water to its radiator and restarted it; later, low oil pressure led them to bring in diesel and try to prime the motors. As sections of the hospital lost power, maintenance workers found that flooding had reached the lower levels where roughly a third of the automatic transfer switches and associated distribution panels were located.

Workers waded through knee-deep basement water to connect some circuits from a failed generator to a working one. The bypass briefly shifted the electrical load, but a gauge indicated that the working engine was drawing too much current, raising concern about a short circuit. Staff tried to separate the loads and shut down circuits serving unused equipment. Another generator failed, and an attempted repair using parts from it did not succeed. At about two in the morning on Wednesday, August 31, nearly forty-eight hours after Katrina made landfall near New Orleans, the last generator surged and died. Survival Mode had organized a hospital trying to endure the emergency, but the system on which that endurance depended could not keep the building powered.

Consequences and Wider Significance

The directive belongs to a wider account of failures that accumulated before and during the disaster. The later assessment of New Orleans’ deaths cited the delayed evacuation order, insufficient buses and drivers, uncoordinated rescue efforts, communications problems, and hospitals and nursing homes that had not evacuated before the storm or invested in backup power and water systems robust enough for a prolonged emergency. Survival Mode addressed the immediate consequences of being trapped in that larger breakdown; it was not a substitute for evacuation or for infrastructure able to withstand the flood.

The book contrasts Memorial’s crisis with the experience of Charity Hospital. Charity had flooded and lost power, plumbing, computers, telephones, and elevators, and it had more than twice Memorial’s patient load across its two campuses with a lower staff-to-patient ratio. Yet fewer than ten patients died there, and transfers were completed on Friday, September 2, a day after Memorial’s evacuation was completed. Charity staff described frequent meetings, a flashlight-lit talent show, and efforts to maintain morale; the hospital had also drilled for a Category Three hurricane and levee failure and acquired portable generators, oxygen-powered ventilators, and a ham radio system with federal preparedness funding. The contrast does not make the two institutions’ circumstances identical, but it shows that a declaration of emergency operations alone could not determine what a hospital was able to do. Survival Mode is significant both as a concrete set of orders and as a measure of the gap between managing a crisis after it arrives and preparing systems capable of enduring it.