Weighing Options and Infrastructure at Hospitals in Flood Zones
When generators failed during Hurricane Sandy at several city hospitals, including Coney Island Hospital, NYU Langone Medical Center and Bellevue Hospital Center, it seemed like a once in a lifetime disaster for the tri-state area. Yet for at least one hospital administrator, it was not completely unexpected.
Martina Parauda, the director of the Manhattan VA Medical Center, ordered patients there to be evacuated not as just a precaution, but because they had experienced something akin to Hurricane Sandy before–during the northeaster of December 1992 that brought a high tide of over eight feet to New York City.
Flooding from the East River, just one block from the Manhattan VA Medical Center, caused a complete power outage in 1992. “I remember very vividly trying to feed the patients,” Parauda said. “We had to form a human food chain from the kitchen all the way up the stairwell.”
As late as 7:17 p.m. on Oct. 28, NYU Langone posted a press release stating they had “activated [their] emergency preparedness plan” but that there weren’t plans to move patients. During the peak of Superstorm Sandy on Oct. 29, administrators at NYU Langone Medical Center were keeping patients in the building. That night the power went down and forced them to make an emergency evacuation.
Dr. Kristi Koenig, a professor of Emergency Medicine and the Director for the Center for Disaster Medical Sciences at University of California, Irvine explained that evacuating is not always the obvious precaution.
According to Koenig, evacuations themselves can be dangerous and even life-threatening for certain patients. Additional issues arise such as placement of patients. “Pretty much all the hospitals are over-census so sometimes you’d end up taking patients to places that are under care,” Koenig said. An example would be an emergency shelter with no technological capability to sustain patients on life-support.Emergency plans at hospitals are vetted by the Joint Commission, a private nonprofit that accredits all hospitals that want to qualify for certain types of funding. Though the commission makes sure that the hospitals have comprehensive plans for all types of emergencies, there is not always a focus on specifics, such as where generator gasoline should be stored. Additionally, the commission’s suggestions are not mandatory so decisions about moving power and hardening infrastructure are left to individual hospitals.
“Your back-up power system, which hospitals are required to have, is really only as strong as its weakest part,” said Dr. Sheri Fink, a ProPublica contributor who has written frequently about hospital infrastructure. “[At] NYU we saw they had invested millions of dollars to improve that structure, and to improve the back-up power system, and to move generators upstairs, but there was still some electrical circuitry that was down in the basement. And when that got flooded, that knocks out the system.”
Even during normal situations, many hospitals are working in conditions that stretch their systems. A survey by the American Hospital Administration (AHA) found that over half of emergency departments in hospitals report operating at or over capacity. Another recent AHA study found that many hospitals had difficulty in maintaining on-call physician coverage for emergency rooms. Still, 85 percent of those same hospitals reported having participated in “large-scale community-wide drills.” Around the same percentage stated they had set up communication networks and had formal plans to share resources during emergencies.
If the manually ventilated patients at NYU Langone Medical Center are any indication, the planning might not have gone far enough. At Coney Island Hospital, protocols set in place also left nurses stranded with patients.
“It was really, really frightening because all of a sudden there were no lights […]no communication. No communication even with the telephones that we have here in the hospital. No communication with any cell phone,” Terry Mancher, Chief Nursing Officer at Coney Island Hospital said. “We were pretty much left totally by ourselves.”