Superstorm Sandy and hospital heroics

By Monday, in anticipation of Hurricane Sandy, over two hundred patients were discharged or transferred from my hospital NYU Langone Medical Center and the Emergency Room was closed. The patients who remained there were all on the upper floors, well out of range for any potential floodwaters.

I wondered at the time whether this precaution would end up being an overreaction since during our previous experience with Hurricane Irene, the hospital had been evacuated and flood waters had not come anywhere near us.

Boy was I ever wrong. By Monday night, surge waters reached close to 13 feet and the Medical Center's basement was flooded, damaging several back-up generators. When the power went out the hospital had no back-up, an instant emergency for all patients (over 300) who remained.
A command center was immediately set up in the lobby with  senior officials from the NYPD, FDNY, paramedics, and the hospital's senior physician and nursing leadership.

Though there was certainly a potential for a Public Relations disaster, the next several hours instead became a road map for coolness and mobilization under pressure that can be instructive for any hospital facing a similar circumstance.

I spoke with Dr. Andrew Brotman, Vice Dean for Clinical Affairs, who was part of the command team. He told me that ramps were quickly constructed to literally slide the patients down the stairwell from the upper floors (as high as 15) to the lobby. Triage was  key, which means that the sickest patients were brought down first. Many of the respirator patients had battery-operated respirators, but 4 tiny infants were successfully brought down using Ambu-bags to physically breathe air into their lungs.

Once in the lobby, plans were quickly made to transfer these patients to other hospitals, including Mt. Sinai, Cornell, Sloan Kettering Memorial, and St. Luke's. Two of my own patients were transferred and did well. Dr. Brotman told me that NYU's own medical and surgical residents went along with the patients to work at the receiving hospital and ensure continuity of care. All the transfers were successful, and none of these patients died. By late morning Tuesday, our hospital was emptied of all patients.

With no power restoration in sight, it is likely that these patients will continue to receive their care at the hospitals who received them.

What lessons can be learned here, beyond the obvious need for surge walls or levies around the city and emergency generators on higher floors? (Even with working emergency power, neighboring Bellevue Hospital is today transferring 500 patients because we still don't have power in lower and midtown Manhattan).

We can certainly learn from the teamwork here; the interdisciplinary heroics exhibited by police, firemen, emergency health workers, nurses and physicians in a way that was reminiscent of 9/11.

New York has shown itself as a city where rescue workers work together well. We can also learn that in the era of Electronic Medical Records, back-up paper charts remain crucial in the event that power is lost.

Finally, we much not overlook the need to protect our hospitals from disasters. We need them the most when citizens are flooded, sent out of their homes, or forced to live without power. During Hurricane Katrina, in addition to drownings, 11% died from heart disease and 25 % from injuries.

We need to protect our hospitals, to protect them like the fortresses they are, so that they will be there for us when we need them the most.