Physician Karen Calkins tends to Mona Guibord, 94, as she waits to be evacuated from Pine Island, Fla., in the aftermath of Hurricane Ian on Saturday. The only bridge to the island is heavily damaged so it can only be reached by boat or air. Gerald Herbert/Associated Press

FORT MYERS, Fla. — Rescuers evacuated stunned survivors on a large barrier island cut off by Hurricane Ian and Florida’s death toll climbed sharply, as hundreds of thousands of people were still sweltering without power days after the monster storm rampaged from the state’s southwestern coast up to the Carolinas.

Florida, with nearly four dozen reported dead, was hit hardest by the Category 4 hurricane, one of the strongest to make landfall in the United States. Flooded roadways and washed-out bridges to barrier islands left many people isolated amid limited cellphone service and a lack of basic amenities such as water, electricity and the internet.

Florida Gov. Ron DeSantis said Saturday that multibillionaire businessman Elon Musk was providing some 120 Starlink satellites to “help bridge some of the communication issues.” Starlink, a satellite-based internet system created by Musk’s SpaceX, will provide high-speed connectivity.

Florida utilities were working to restore power. As of Sunday morning, nearly 850,000 homes and businesses were still without electricity, down from a peak of 2.67 million.

At least 54 people were confirmed dead: 47 in Florida, four in North Carolina and three in Cuba. The weakened storm had drifted north on Sunday and was expected to dump rain on parts of Virginia, West Virginia, Maryland and southern Pennsylvania, according to the National Hurricane Center, which has warned of the potential for flash flooding.

More than 1,000 people were rescued from flooded areas along Florida’s southwestern coast alone, Daniel Hokanson, a four-star general and head of the National Guard, told The Associated Press while airborne to Florida.

In Washington, the White House announced that President Joe Biden and first lady Jill Biden would travel to Florida on Wednesday. But a brief statement did not release any details of the planned visit.

Deanne Criswell, administrator of the Federal Emergency Management Agency, said the federal government has been focused on getting resources to needy victims in Florida.

She told “Fox News Sunday” that the federal government began to preposition the “largest amount of search and rescue assets that I think we’ve ever put in place before” – FEMA search and rescue, Coast Guard, personnel from the departments of Interior and Defense – to supplement the state of Florida’s resources.

The bridge to Pine Island, the largest barrier island off Florida’s Gulf Coast, was destroyed by the storm, leaving it accessible only by boat or air. The volunteer group Medic Corps, which responds to natural disasters worldwide with pilots, paramedics and doctors, went door-to-door asking residents if they wanted to be evacuated.

Some flew out by helicopter, and people described the horror of being trapped in their homes as water kept rising.

“The water just kept pounding the house and we watched, boats, houses – we watched everything just go flying by,” Joe Conforti said, fighting back tears. He said if it wasn’t for his wife, who suggested they get up on a table to avoid the rising water, he wouldn’t have made it: “I started to lose sensibility, because when the water’s at your door and it’s splashing on the door and you’re seeing how fast it’s moving, there’s no way you’re going to survive that.”

The bridge leading from Fort Myers to Pine Island, Fla., is heavily damaged Saturday in the aftermath of Hurricane Ian. Due to the damage, the island can only be reached by boat or air. Gerald Herbert/Associated Press

River flooding posed a major challenge at times to rescue and supply delivery efforts. The Myakka River washed over a stretch of Interstate 75, forcing a traffic-snarling highway closure for a while before officials said later Saturday that it could be reopened.

While swollen rivers have crested or are near cresting, the levels aren’t expected to drop significantly for days, National Weather Service meteorologist Tyler Fleming said.

Elsewhere, South Carolina’s Pawleys Island, a beach community roughly 75 miles up the coast from Charleston, was also hit hard. Power remained knocked out to at least half the island Saturday.

Eddie Wilder, who has been coming to Pawleys Island for more than six decades, said it was “insane” to see waves as high as 25 feet wash away a landmark pier near his home.

“We watched it hit the pier and saw the pier disappear,” he said. “We watched it crumble and and watched it float by with an American flag.”

Wilder’s house, located 30 feet above the shoreline, stayed dry inside.

In North Carolina, the storm downed trees and power lines. Two of the four deaths in the state were from storm-related vehicle crashes, and the others involved a man who drowned when his truck plunged into a swamp and another killed by carbon monoxide poisoning from a generator in a garage.

At Port Sanibel Marina in Fort Myers, Florida, the storm surge pushed several boats and a dock onshore. Charter captain Ryan Kane said his vessel was so badly damaged that he was unable to use it to help rescue people, and now it will be a long time before he can take clients fishing again.

“There’s a hole in the hull. It took water in the motors. It took water in everything,” he said, adding: “You know, boats are supposed to be in the water, not in parking lots.”

Lee County officials ordered residents to evacuate Tuesday, a day later than some other counties in the area did.

Fort Myers Mayor Kevin Anderson on Sunday defended Lee County officials from accusations that they had been slow in ordering evacuations ahead of the storm.

“Warnings for hurricane season start in June. So there’s a degree of personal responsibility here. I think the county acted appropriately. The thing is, a certain percentage of people will not heed the warnings regardless,” Anderson said on the CBS show “Face the Nation.”

Separately, DeSantis on Friday noted that many forecasts placed Ian’s landfall north of Lee County and said officials there acted appropriately once models began to center on the county.

Kinnard reported from Pawleys Island, South Carolina; Associated Press contributors include Freida Frisaro in Miami; Brendan Farrington in Tallahassee, Florida; Gerald Herbert in Pine Island, Florida; Mike Pesoli in Lehigh Acres, Florida; Sarah Rankin in Richmond, Virginia; and Amy Forliti from Minneapolis.