Near midnight on Friday, August 26, as Hurricane Irene menaced North Carolina on its direct path to New York City, NYU Langone Medical Center made an urgent call to Greater New York Hospital Association's desk at the City's Office of Emergency Management. One of seven hospitals ordered to evacuate in advance of the hurricane, NYU Langone desperately needed to locate beds for three extremely ill ICU patients.
Lacking immediate nearby options—hospitals throughout the City and on Long Island had been taking in evacuated patients all day and were at capacity—GNYHA called Hartford Hospital CEO Jeffrey Flaks at home, and the former New York hospital executive immediately arranged for a helicopter to transport the patients. When the weather grounded that plan, ambulances traveled the 125 miles to Manhattan, and by Saturday morning all three patients were resting safely in Connecticut.
Hartford's no-questions-asked response mirrored the heroic efforts of dozens of hospitals and health systems big and small, and enabled New York's health care community to overcome immense logistical challenges and safely evacuate—and subsequently repatriate—thousands of hospital and nursing home patients.
To be sure, the going wasn't always smooth. New York City had not ordered hospital evacuations in anyone's memory, and there were moments as Irene closed in and travel became more dangerous that it looked like some evacuations would not be completed in time. But a relentless “can do” attitude, creative problem solving, tremendous communication and cooperation between hospitals and government agencies, timely leadership, and a strong emergency preparedness infrastructure ultimately proved decisive.
Perhaps most important, we learned. We worked around the clock for nearly six days and took away valuable lessons that can be applied to all hospitals and across all emergencies.
Lee Perlman
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While 9/11 completely redefined hospital emergency preparedness across the nation, GNYHA has always devoted significant resources to our hospitals' emergency preparedness infrastructure and to ensuring that an “all hazards” approach enables them to respond to the wide range of emergencies and disasters that could take place in the New York region. So when Hurricane Irene emerged as a threat, we were ready.
Days before Irene's arrival—and before Mayor Michael Bloomberg issued his “Zone A” evacuation order for NYU Langone, Staten Island University Hospital (two sites), Coney Island Hospital, and Manhattan's VA Hospital and nearly a dozen nursing homes (several hospitals and nursing homes on the Rockaway Peninsula were subsequently ordered to evacuate as well)—hospitals were already reviewing their internal emergency preparedness checklists for staffing plans, communications systems, power systems, supply and other resource needs, and evacuation and sheltering plans.
Susan Waltman
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And in coordination with GNYHA, OEM, and the State and City health departments, hospitals also identified specific needs, which enabled GNYHA to help several hospitals receive sandbags, cots, a back-up generator, emergency lighting, and sheets, towels and blankets—all in advance of Irene.
Not for the first time, we were reminded of the tremendous value of easy-to-read checklists that are accessible to all shifts, and that there's no such thing as too much preparation.
No emergency follows a script, and the evacuation order forced both GNYHA and its member hospitals to make adjustments on the fly to facilitate the safe, orderly, and timely transport of thousands of vulnerable hospital patients and nursing home residents. From the GNYHA desk at OEM, we were in touch with our members around the clock and could help locate beds for evacuees.
While New York's densely clustered hospitals are usually regarded as competitors, it was in the spirit of collaboration that hospitals like the bustling Kingsbrook Jewish Medical Center in Brooklyn boldly took in more than 200 evacuated patients. And it was through communication and swift action that the New York City Health and Hospitals Corporation found beds for all of Coney Island Hospital's patients and the North Shore-Long Island Jewish Health System did the same for Staten Island University Hospital and several other hospitals.
In the process, we learned that during evacuations hospitals must be open to using non-traditional space for accepting new patients, and must have plans for their staffs to accompany patients when they are evacuated.
True leaders “lead from the front,” and no one demonstrated that more than State Health Commissioner Dr. Nirav Shah, City Health Commissioner Dr. Thomas Farley, and OEM Commissioner Joseph Bruno. Their all-hours, hands-on leadership at OEM headquarters set an example that GNYHA and the hospital community spiritedly followed. Dr. Shah personally called numerous hospitals at the height of the evacuations to encourage their tired, anxious staffs to hang in and keep up their great work. He also made important decisions, including giving hospitals the authority to exceed their operating certificate capacity and take on more evacuees.
Without such superb leadership at the top, the response to Irene may well have been far less successful.
Like the urgent call to Hartford, the simple power of relationships—person to person, organization to organization, and GNYHA's ties to its members and state and local agencies—paid immense dividends throughout the emergency and ensured a coordinated, comprehensive response. In just one of myriad examples, when OEM issued an emergency food request so evacuees filling the City's “special needs” shelters were adequately fed, GNYHA's business subsidiary GNYHA Ventures immediately called its longtime business partner U.S. Foodservice, which got trucks loaded with non-perishable items to the shelters in less than eight hours.
The health care community is nothing if not a series of relationships, and Hurricane Irene highlighted their tremendous importance.
In an uncertain world, we can be certain there will always be a "next time" for hospitals to prepare for, and respond to, an emergency. When that time comes, we hope the lessons learned from Hurricane Irene—the importance of preparation, a reliable internal checklist, communication and cooperation, strong leadership, trusting relationships, and “can do” problem solving—help our fellow hospitals to meet the challenge.
Lee Perlman and Susan Waltman are executive vice presidents of the Greater New York Hospital Association.
