Due to the massive destruction in Puerto Rico, Louisiana again wanted to assist in any way they could so R-S-I was again deployed. In November, R-S-I deployed to Puerto Rico to manage one of the largest Medical Special Needs Shelters on the island. Upon arrival the R-S-I team assumed management of over 40 patients from the DMAT team. The shelter was housed in a condemned wing of a heavily damaged hospital. Patient acuity levels would have normally placed most of these patients within an acute care hospital, but due to the extensive damages to all structures across the island, these patients were placed in this makeshift shelter. Our staff was comprised of Physicians, Pharmacist, Nurses, Respiratory Therapists, Paramedics, EMTs, CNAs and administrative staff. Our original deployment was for 14 days, but was extended an additional 10 days because not all patients were discharged and there were no other suitable facilities to transfer the remaining patients. R-S-I deployed additional staff to meet the needs. At the end of the 24-day deployment, R-S-I staff discharged the remaining patients and demobilized the shelter. Two rewarding memories that most staff walked away with from this deployment, was the strong appreciation the patients had for the quality and personal care they received from our staff. Both patients and family members constantly thanking staff for a level of care they had never received prior. The second memory was the recovery that many patients obtained while under the care of our staff. One case in particular was a bed bound patient of 2 years, that upon discharge was using a walker. This came about because of the patient’s determination and the support of all our staff to provide therapy whenever possible.