Sound preparation, vigilant care for patients and staff
Members of America’s Essential Hospitals often are called upon to deliver health care in the face of complex natural disasters. In late October 2012, NuHealth/Nassau University Hospital Corporation on Long Island, New York City Health and Hospitals Corporation, and Stony Book University Hospital, also on Long Island, used their prior emergency management training and experience as first responders to ensure the safety of patients and staff before, during, and after Hurricane Sandy.
Sandy made landfall in the United States on Oct. 29, 2012, as a post-tropical cyclone near Brigantine, N.J. “Because of its tremendous size, however, Sandy drove a catastrophic storm surge into the New Jersey and New York coastlines. Preliminary U.S. damage estimates are near $50 billion, making Sandy the second-costliest cyclone to hit the United States since 1900,” says a February 2013 National Hurricane Center report.
Preparing patients, building resources
Planning ahead was critical for ensuring hospitals had the resources and back-up they needed to provide continuous care for patients during the storm. Nassau University Medical Center (NUMC), in Nassau County, N.Y., began preparing Friday, Sept. 26, by providing staff, beds, food, medication, and other support for approximately 55 acute care patients, 35 nursing home patients, and 20 psychiatric patients from nearby Long Beach Hospital, which was forced to obey a mandatory evacuation order for nursing homes on Barrier Island. “The movement of roughly 100 patients went smoothly, highlighting the importance of teamwork, anticipation, and planning in such emergencies,” says NuHealth medical director Steven J. Walerstein, MD, in a blog post. “Little did we know what was about to befall the Long Beach community, but luckily their most vulnerable patients were safe from the storm.”
Nearby, New York City Health and Hospitals Corporation (HHC) used its offsite emergency information technology system, which duplicates HHC’s city database, to prepare patient records for the storm. “We have designed a great deal of redundancy into our information technology infrastructure, including two data centers [located at HHC’s Jacobi Medical Center in the Bronx and at a secure data facility in New Jersey], each capable of running all of our mission critical IT applications,” says HHC President and CEO Alan D. Aviles.
Adapting, evacuating amid the storm
Once the storm hit, even though New York City saw extreme destruction and flooding, HHC was able to keep most facilities open. HHC relied on its multihospital system to transfer about 40 patients from low-lying Coney Island Hospital to Kings County Hospital Center in Brooklyn on Sunday. HHC’s Bellevue Hospital Center, along Manhattan’s East River, began evacuating its most critical patients Monday, when the storm surge hit. According to a report from The New York Times, the evacuation accelerated dramatically Wednesday when waterlogged fuel pumps for the hospital’s backup power generators failed and shut the facility down. Working with the community, the state health department, and the National Guard, Bellevue evacuated and relocated its remaining patients.
Bellevue wasn’t the only hospital to experience unexpected damage during the storm. The Wall Street Journal reported that Stony Brook University Hospital (SBUH), which maintained continuous operations during the storm, received patients from Eastern Long Island Hospital in Greenport, N.Y., which was forced to evacuate Monday due to flooding.
Because of the additional patients NUMC took in prior to the storm, the hospital averaged 500 to 550 patients before Sandy made landfall – about 100 to 150 more than its typical 400 per day. Once the storm hit, NUMC’s emergency operations center was “open round-the-clock to respond to the aftermath of the storm, centrally managing our staffing, logistics, and coordination with other hospitals and with first responders,” says NuHealth President and CEO Arthur A. Gianelli, MA, MBA, MPH.
Supporting staff in the aftermath
Hospital staff worked through the storm despite their own struggles at home. “Thirty-eight of our own staff lost housing, while others needed child care, food, and a variety of support, even as they continued to care for patients,” Walerstein says. To assist staff who had problems refueling their vehicles, NuHealth scheduled regular fuel shipments to its nursing home and allocated five gallons of gas to employees who otherwise could not make it back to work. NuHealth also partnered with a local gas station owner to dedicate a pump to hospital and nursing home employees. Similarly, SBUH offered shelter with access to hot showers and food for those staff who needed to stay on-site.
Working together with county and state emergency operations center staff, and staff from the Disaster Medical Assistance Team (DMAT) and the National Public Health Service (NPHS), NuHealth provided essential care for a substantially elevated number of patients. Gianelli credits the hospital’s success to regular meetings in the emergency operations center and proactive facility management to ensure safe care and swiftly address employee needs.
In the months since the storm, hospital operations for these members have largely returned to normal. But the challenges and lessons learned will stay with them and become part of their playbook for the future.