No Walls, No CT, No Backup: Street-Level Emergency Medicine After a Hurricane

In the immediate aftermath of a Category 5 hurricane, with maximum sustained winds approaching 200 mph, emergency clinicians volunteering outside the United States on an island were forced to practice emergency medicine after infrastructure had collapsed. With hospitals damaged or nonfunctional and outside assistance delayed, care was delivered in the streets, shelters, and improvised treatment areas under austere conditions. This session explores how core principles of emergency medicine become even more critical when the street becomes the emergency department and clinicians are working in a resource limited, international disaster relief setting. The lecture opens by framing the post hurricane environment encountered during the mission: flooded neighborhoods, impassable roads, disrupted communication, delayed response times, and overwhelmed or inaccessible healthcare facilities. Attendees are introduced to the realities of austere emergency medicine in a post disaster island setting, where patient volume is high, resources are scarce, and providers must balance individual patient needs with population level survival. Emphasis is placed on situational awareness and scene safety, including environmental hazards, unstable structures, and evolving security concerns unique to disaster zones outside the U.S. A central focus of the lecture is real time triage in chaotic conditions. Traditional triage models are reviewed and adapted to the disaster relief environment, highlighting how decisions must be made rapidly with limited information and minimal diagnostic capability. Learners examine how to prioritize care when evacuation is delayed, supplies are finite, and definitive treatment may be hours or days away. Case based scenarios drawn from the mission illustrate the emotional and ethical challenges of deciding who can be helped immediately, who must wait, and who may be beyond available care. Improvisation is presented as a core clinical skill rather than a last resort. The lecture discusses creative approaches to wound management, splinting, airway support, and pain control using minimal equipment. Special attention is given to managing chronic medical conditions, pediatric patients, and vulnerable populations during prolonged disaster response. Finally, the lecture addresses the human side of disaster response. Providers must manage fatigue, moral distress, and cognitive overload while working in emotionally charged environments far from home. Strategies for maintaining team communication, supporting mental resilience, and recognizing personal limits are discussed. The session concludes with key takeaways on preparation, training, and mindset, emphasizing that effective street level emergency medicine after a hurricane relies less on technology and more on clinical judgment, teamwork, and adaptability.