I was a geology major, I eat this stuff up. If you know nuch about the Mississippi, you know that the system of levees, and the dredging over the years has caused the Mississippi to be above grade in many places, such as New Orleans. If a large enough quake hits, the river will probably change its course, the mouth likely to relocate where I sit right now (over a period of time) We're talking disaster of biblical proportions, mass forced evacuations, social disorder, dog & cats living together, you know, pandemonium! Standards of care would go out the window, state and county lines would be ignored by EMS providers, picking up and transporting wherever needed. It'd be really bad in winter. Diseases would throw in their 2 cents shortly afterward, cholera, dysentery, flu. As refugees ran out of cash and fuel they'd be stranded along roadways and in little towns with few resources to help them. Community ED's would become primary care, and less able to transfer out the bad stuff that comes their way. We would be treating and releasing in the field. Those whose blood boils when the frequent flyers call would finally be allowed to vent on them, and refuse to transport. "You don't need our services!" All this would be right before FEMA took over administration of the affected areas. And imposed order with troops. If overseas wars were still ongoing, get ready, the draft would make a comeback. Especially medical personnel. They just raised the minimum age for enlistees.