SAN JUAN, Puerto Rico –
Maria. She reached landfall September 20th over Puerto Rico as a Category 4 hurricane in the early hours of a Wednesday morning. The Lesser Antilles, including the U.S. Virgin Islands, already faced the full strength of Maria as a Category 5 hurricane by that time.
In midstride the island commonwealth's power and water services halted, even for its 68 hospitals. Millions of Puerto Rican storm survivors found themselves without medical care either due to loss of employment or from the loss of the local hospital itself.
According to Rafael Rodríguez-Mercado, the secretary of health for the government of Puerto Rico, only 17 hospitals still had direct communication with the Department of Health of Puerto Rico due to the lack of electricity across the island. Survivors on the U.S. Virgin Islands had hospitals that could only provide a minimal level of care after the storm.
The media reported patients dying in hospitals due to the lack of electricity and services. This amplified the public's concern for Puerto Rico and the federal government's response. President Trump signed the emergency declaration for Puerto Rico beginning on Sept. 17. FEMA took the roll of coordinating all disaster relief efforts.
A multitude of military units, active and reserve, and a joint operation from all branches mobilized to the island. A wide range of medical units mobilized to work side-by-side with the Department of Health and Human Services (HHS) teams and FEMA in support of the Puerto Rico Department of Health.
Their mission placed them in major cities like San Juan but also across the central mountain range from Caguas to Barranquitas to Utuado, and the coastal plains surrounding the island, particularly the Southeastern corner flattened by Maria's landfall.
The loss of medical services lead to more deaths and demonstrated the need for military response. Task Force Medical formed out of that response.
The 62nd Medical Brigade arrived in San Juan on Oct. 11 to coordinate the military medical treatment facilities that sprang up on the island, including a fleet of ambulances and life-saving surgical and intensive care units.
By that time many of the units were already operating on the ground, especially the Army Reserve and National Guard units from Puerto Rico. In total, the task force coordinated 11 units in over a dozen different locations across Puerto Rico and the U.S. Virgin Islands. In addition, United States Navy Ship (USNS) Comfort docked in San Juan October 3rd, providing the full capability of a hospital with hundreds of Navy personnel. Over two thousand survivors saw care in the ship itself and in a facility established on the dock.
The 602nd Area Support Medical Company (ASMC) deployed to Saint Thomas of the U.S. Virgin Islands. They provided care to over a thousand patients. The 575th ASMC provided the same capability to the island of Saint Croix. Medical treatment facilities established on those islands treated patients and prepared them for travel to larger facilities on Puerto Rico when necessary.
The Humacao Arena, normally a stadium for local sports, became the home of the 14th Combat Support Hospital (CSH). Their mission was to relieve the pressure on local hospitals while power and water returned.
The Arena stood tall against the surrounding coastal plain, where trees lay sideways or stripped of their greenery. Storm survivors came to the arena from all over the Southeastern region of the island where Maria began her devastation. Patients at nearby Ryder Memorial Hospital had to be evacuated and brought to the arena after a generator failed.
Disaster Medical Assistance Teams (DMAT), a professional emergency medical response force under HHS, came to assist the 14th CSH and other units. The overwhelming need for primary care requests from the people of Puerto Rico who had no doctor to visit required DMAT intervention.
In the Northwest coastal area of Aguadilla, the government closed the area's El Buen Samaritano hospital due to the storm. The Army Reserve's 335th ASMC, of Puerto Rico, established a medical facility there. Due to the needs of storm survivors they needed extra military and civilian medical staff support. The Air Force's 331st Expeditionary Medical Support Team and a DMAT came in to support soon after the storm. They provided primary care services, which were sorely needed with the loss of El Buen Samaritano.
At Aguadilla the 335th and 331st combined treated over five thousand patients.
"It was a huge help to the ASMC," said Col. Teresa Duquette-Frame of the 62nd Medical Brigade, the unit responsible for coordinating the entire task force, "One of their physicians was so exhausted he ended up being hospitalized with pneumonia. That's how busy they were. They were seeing over 300 a day."
Puerto Rican Army Reserve units like the 49th Multifunctional Medical Battalion (MMB) pulled Soldiers from stateside units in their command to the affected areas. Soldiers of the 49th MMB took on many roles to provide relief. They delivered food and water, installed protective tarps over homes and shelters, and cleared debris from homes and roads.
The 407th Medical Company (Ground Ambulance) of the Puerto Rico National Guard provided emergency medical care on location and transportation for patients to the appropriate hospital or shelter. An ambulance from the 407th was provided for every ASMC and DMAT facility on Puerto Rico. The 407th also transferred patients out of the military medical facilities to civilian hospitals in the weeks that followed.
Spanish is the primary language of Puerto Rico. Units from the island also provided accurate translations from patients to healthcare providers.
"DMAT personnel kept telling us they could not have done this without us. Being able to translate for them so they could render proper care to the patients had great impact on this mission and they could not be any happier for that," said Sgt. Hector Berrios, an ambulance driver and medic with the 407th who was stationed at the DMAT facility established at the Hima San Pablo hospital in Fajardo. Berrios, an airport ramp agent for his civilian job, had to be notified in person by his unit to mobilize for the emergency response. Berrios said with the power lines down and limited telecommunication available the members of the 407th went door-to-door to get the word out.
However, fortune favored the 407th as the unit was equipped with additional Four-Litter Ambulances, a kind of Humvee, shortly before Maria. "It helped us a lot," said Berrios, "With the number of vehicles we had it was tight for us to work with, but we were able to do it. Wherever they needed us we were responding."
Over time, the military medical units of the task force will return to their home station but FEMA and the DMATs will remain. The eventual departure of the USNS Comfort will signal the ability of civilian medical care to take care of most situations. Currently, all but one of the 68 hospitals have returned to normal operations, according to Rodríguez-Mercado. The final hospital is already making preparations to accept patients this week.
"We were able to help assist and decompress those facilities as they recovered and give people time to take care of their own homes as we provided treatment ... and hopefully some relief," said Maj. Christopher Wingate, the operations officer for the 62nd Medical Brigade.
Many of the units involved in Task Force Medical were designed for a different kind of mission. They train to provide emergency medical care in the event of a terrorist attack, and they rarely provide medical care in one place for too long, said Duquette-Frame.
Rodríguez-Mercado said the teamwork between HHS, the Department of Defense, and the Department of Health prevented the deterioration of a healthcare system strained by Hurricane Maria and Irma. "I think this was the most significant effort ever made in the island where the federal component and the state component worked together for one purpose: the health of the people of Puerto Rico."
Nearly 12,000 patients were treated in a four-week period throughout Puerto Rico and the Virgin Islands by Task Force Medical units, many of them severe.