The Role of the Emergency Medical Services Medical Director and Natural Disasters: The Sarasota, Florida Experience During Hurricane Milton.

The state of Florida prepares for hurricanes annually, particularly from late summer to fall. These hurricanes put immense pressure on public services, especially emergency medical services (EMS). This paper highlights the critical role of the EMS medical director in Sarasota, Florida, within the community during disaster response. It outlines the medical director's responsibilities, situations, protocols, and limitations encountered during Hurricane Milton. Specifically, this paper will illustrate a series of cases and their responses during periods of severe winds, which forced 9-1-1 services, including ambulance and fire, to remain at their stations due to dangerous weather. On October 9th, 2024, Hurricane Milton made landfall in southwest Florida around 20:30. It struck the barrier island of Siesta Key in Sarasota County, which spans 550 square miles and has a population of 469,013. The county reported winds exceeding 120 miles per hour. In the wake of Hurricane Milton's landfall, a record 47 tornadoes simultaneously appeared across the state, leading to widespread destruction. Milton is associated with at least 24 fatalities in Florida, with seven deaths directly linked to the tornadoes. This paper reviews the highest acuity cases and the medical director's role in them, including incidents of carbon monoxide poisoning, a power generator explosion resulting in severe burns, pediatric cardiac arrest, uncontrolled hemorrhage, and hypoxia in individuals dependent on oxygen due to a power outage. The authors recognize that protocols may differ from state to state. However, the goal here is to compile relevant cases to present to the EMS community to better understand the events that transpired, aimed at improving future disaster response when hazardous weather restricts standard on-scene EMS operations. The Sarasota County EMS system believes that out-of-hospital patients are under the care of the EMS medical director until they reach an emergency department. The aim is to clarify the medical director's specific roles by analyzing several cases and their outcomes, where known, and the lessons learned by the medical director, Sarasota County Dispatch, and Sarasota County EMS during periods of inactivity caused by heavy winds accompanied by several recommendations based on these experiences.