By Jennifer Larson, contributor
November 2, 2012 - Some called the massive hurricane-turned-storm that just battered the Caribbean and the East Coast of the United States “a perfect storm.” Others referred to Sandy as a “superstorm” while others called it “Frankenstorm” because it arrived just before Halloween.
Regardless of the nomenclature, Sandy was a brute force that caused extensive damage in the northeastern states, particularly New Jersey and New York, with intense wind and rain. Sandy downed numerous trees and power lines and sent waves of seawater flooding into the streets and buildings of places like lower Manhattan in New York City, Staten Island and Hoboken, N.J. More than 95 people in the United States have been reportedly killed in the storm, and the number keeps growing.
In natural disasters, hospitals become a focal point. Their staff care for the wounded and sick, but they also face challenges in doing so. Sandy threatened the operations of a number of East Coast hospitals, as the electricity and communications networks went down. Luckily, other hospitals were better able to weather the storm and help out.
Evacuations in New York City
As the storm surged, water flooded into the basement of NYU Langone Medical Center, which is located near the East River. On Monday, October 29, the backup generators failed.
The hospital staff was forced to evacuate more than 200 critical patients to other facilities. Many patients were carried down multiple flights of darkened stairwells on gurneys and taken to ambulances for transport. Some were connected to battery-operated respirators and monitors during transit.
Some of the patients who were evacuated were premature infants and children from the medical center’s NICU and PICU. Many will undoubtedly remember the television footage of one of the hospital’s nurses manually ventilating a tiny infant from the intensive care unit, as she carefully carried the fragile baby out of the hospital.
Some patients were taken to the Upper East Side to Memorial Sloan-Kettering Cancer Center, which had continuous power throughout the storm, while more than 60 were taken to Mount Sinai Medical Center, which also maintained power. Mount Sinai staffers, including many nurses and nursing leaders who had brought their suitcases to work in anticipation of staying there throughout the storm, were ready and waiting.
“We were a stable force,” said Beth Oliver, RN, MS, vice president of nursing at Mount Sinai Heart. Our nurses and our health care team were able to just take these patients, these critically ill patients, and they gave off such a sense of security.”
On Tuesday night, Carol Porter, DNP, Mount Sinai’s chief nursing officer and senior vice president, took a few moments to reflect as she walked through the busy hospital. “I just got a sense that it was a solid fortress,” she said. “We were safe, and we were so proud that we could help the other hospitals out.”
Mount Sinai also accepted patients from Bellevue Hospital Center, the city’s flagship public hospital, on October 31. According to the New York Times, Bellevue had been operating on backup generators for some time but finally had to begin moving patients out to a number of local hospitals. Bellevue evacuated about 500 patients altogether.
Half of New Jersey’s hospitals relied on backup power
Neighboring New Jersey was hit hard by Sandy.
“We as a state were very well prepared for the storm,” said Kerry McKean Kelly, spokeswoman for the New Jersey Hospital Association. “However, it was a massive storm.”
It was hard, but it could have been worse.
“We only had two hospitals that had to go offline for a period of time,” she continued. “The rest of the state’s hospitals have maintained constant service through some pretty horrendous conditions. That’s testament to their planning and also testament to the commitment of their staffs.”
Hoboken University Medical Center arranged for patients to be moved out on Sunday night in advance of the storm, and Palisades Medical Center evacuated patients on Wednesday, October 31, after the backup generators were compromised by floodwaters. Neighboring hospitals that were able to take on extra patients did so. Elective surgeries and procedures were cancelled so that staff and space were available to care for them and for their existing patients and emergent cases.
As a result of the storm, about 30 hospitals, or half of the state’s hospitals, were functioning with backup generator power on Monday, October 29, Kelly said. Fortunately, she pointed out, that number had decreased to five by late afternoon on Thursday, November 1.
By then, the floodwaters that had swamped towns like Hoboken had largely receded, but huge numbers of people were still without power. Palisades Medical Center had regained power, but Hoboken University Medical Center was continuing to work with the state department of health and hoped to go back into operations within a few days.
As the flood waters recede and the clean-up efforts get underway, the “What if…?” and “What now?” questions have already begun.
For example, some are questioning why hospitals like NYU Langone stored their generators in basements and lower floors that made them vulnerable to flood damage. According to a CNN report, NYU Langone was already planning to replace its generators in a renovation, as it is embarking on a building campaign. But Sandy pre-empted them.
These types of questions will undoubtedly lead to assessments. Some have already begun; Politico Pro reported that the Centers for Medicare and Medicaid Services have announced they are reviewing the power failures at hospitals like NYU Langone.
“I’m sure there will be a period of assessing what went well and what needs improvement so we’ll be better prepared the next time,” Kelly said of the state of New Jersey.
Could these types of assessments lead to better, stronger planning for the future? In a natural disaster, the value of concerted advanced planning becomes evident. According to a recent report from the National Academy of Sciences, more coordinated and resilient preparation efforts will be needed to meet potential future challenges.
Monica Schoch-Spana, PhD, a member of the Committee on Increasing National Resilience to Hazards and Disasters, said that the planning must include proactive efforts to reduce the impact of a potential event, as well as plans for coping with an event once it occurs.
It’s not just about hospitals establishing preparedness plans on their own. “They have to be advocates for community-wide planning that reduces potential disaster risks, so they have to be supportive of comprehensive disaster planning in a jurisdiction at large,” she explained.
Additionally, she said, preparedness must be an ongoing process. “You always have to be updating and revising plans relevant to changes” in population, demographics, buildings and facilities, and even changes in nature, she said.
Porter said that her staff at Mount Sinai was prepared for a disaster, thanks to regular disaster preparation drills, as well as from previous experience from hurricanes, blizzards and other storms. Mount Sinai’s emphasis on advance preparation enabled them to accommodate and care for the evacuated patients while continuing to care for their own patients. They knew what to do, and they were ready to focus on patient safety.
“It was the best it could be for an emergency situation,” she said.
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