Superstorm Sandy made landfall on the evening of October 29, 2012. The storm caused severe flooding, power outages, and billions of dollars in damage to New York City and surrounding areas. The storm forced the evacuation and closure of Bellevue Hospital, the oldest public hospital in the United States and the primary teaching site for the New York University (NYU) School of Medicine.
In its long history, Bellevue has survived natural disasters as well as blackouts, plane crashes, terrorist attacks, the height of the AIDS epidemic, and the associated resurgence of TB in the city. Before Superstorm Sandy, none of these events forced the evacuation or closure of the hospital.
In this context, one can imagine the significance of a storm that forced the hospital to evacuate and remain closed for several weeks. Although the size and strength of Superstorm Sandy were unprecedented, the outcome could have been much worse if the preparedness of the staff at Bellevue had not been tested and refined during Hurricane Irene, 1 year before Sandy.
Hurricane Irene approached New York in August 2011. Aside from the winds and rainfall, the main concern was the storm surge that could potentially flood parts of the city. Before the storm arrived, Manhattan was declared in a state of emergency, and mandatory evacuation of low-lying areas was ordered. Although the city’s hospitals were well prepared to accommodate victims of external disasters, this situation forced them to evaluate their readiness for flooding and possible loss of power.
Bellevue’s internal examination revealed that its power supply was its most significant vulnerability. If the hospital was to lose main power, it would depend on backup generator power. The generators, located on the 13th floor, would not be directly affected by flooding. However, the generator’s fuel pumps, located in the basement, would fail if submerged. This would result in a total loss of power to the hospital.
To address the vulnerability of the backup generator fuel pumps, they were encased within protective structures and sealed by submarine-style doors. This intervention would, it was thought, allow the pumps to continue functioning even if the basement flooded.
Sandy was expected to bring a storm surge of approximately 11 ft. As a reference, flooding would begin when the storm surge reached 6.7 ft.
In preparation for the storm and the planned suspension of public transit, many staff members, including ICU leadership, arrived before the storm. They came prepared to stay for the duration of the event.
At approximately 9:00 p.m., there was a brief loss of power, followed by a return of emergency lights and outlets. The hospital was now operating on generator power. Millions of gallons of water were rushing into the basement, which had been dry less than 2 hours earlier.
Although some elevator service should have remained while on generator power, water could be heard rushing into the elevator pits and all elevator service was lost.
Cell phone service was inconsistent, but landline telephones remained functional at that time.
At 10:00 p.m., the mechanisms protecting the generator fuel pumps failed. The pumps were now submerged, and all power would be lost when the generators ran out of fuel. This was likely to occur in the next two hours.
High-tide arrived at 10:30 p.m. and brought a massive 14-ft storm surge, well above the predicted 11-ft surge. The view from any window in the ICU revealed that the hospital was completely surrounded by water.
While we were working under the assumption that generator power would be lost, National Guard troops and hundreds of hospital staff members, ranging from hospital administrators to custodial workers, began carrying fuel from the ground up to the generators. They were able to form a continuous brigade, standing shoulder-to-shoulder up 13 flights of stairs. They passed the drums of fuel up to one final person, who carried the drum up a small ladder and poured it into the generator fuel tank. In the end, this brigade worked through the night and the following day and managed to supply the generators with enough fuel to last approximately 72 hours. This tremendous effort prevented the hospital from being thrown into total darkness, and protected countless patients from harm.
Soon after avoiding a power blackout, we suffered a communication blackout. Cellular networks were either damaged by the storm or overwhelmed with traffic. Our medical center e-mail server had gone offline. Hospital landlines, including the emergency phones, had been damaged by the flooding. Two-way radios had been distributed for emergency communications, but there were too few to handle such a massive coordinated effort. Essential information could be exchanged between the ICU and the command center only by sending messengers up and down 10 flights of stairs.
At midnight, because of the high likelihood that wall oxygen would be lost, National Guard troops began carrying H-cylinders of oxygen, each weighing 180 pounds, from the ground floor to the 10th floor. Many of these cylinders were carried up the stairs by teams of two National Guardsmen, providing a short-term supply of oxygen if central oxygen were to fail.
At daybreak on Tuesday, October 30, the view from the ICU confirmed that the rain had lightened, the wind had died down, and the floodwaters had begun to recede. Although it became easier to see what the storm had left behind, it became more difficult to see what lay ahead. Main power could not be restored in the near future and the generators were running on a limited supply of fuel. Without a reliable power source, we could not care for our patients indefinitely. Evacuation would be necessary. This enormous project would have to be achieved while conditions within the hospital were rapidly deteriorating. Vacuum power had been lost and patients were being suctioned via syringes attached to suction catheters. Food and water supplies were running low. Trash began filling the hallways. All 1,000 toilets could only be described as unusable, and staff members were forced to use bedside commodes in empty patient rooms. Many members of the hospital staff, despite these conditions and their concerns about their own homes and loved ones, chose to stay and assist with the evacuation.
The first patients to be evacuated, those on mechanical ventilators or requiring dialysis, were prepared for transport and carried downstairs by anyone willing to help. This included physicians, nurses, medical students, and ambulance crews. Although inspiring, the efforts were inefficient. Some patients, weighing as much as 185 kg, could only be carried by two teams of National Guard troops working in shifts and would require hours to successfully evacuate.
By midday on Wednesday, October 31, the conditions outside had greatly improved. News of our situation had spread, and ambulance crews poured in from all over the country. They represented Alabama, Colorado, Connecticut, Illinois, Louisiana, Michigan, Ohio, and many others. At the same time, more than 300 additional National Guard troops arrived to assist in the evacuation. With this additional help, the pace of the evacuation changed. The huge number of ambulance crews was able to mass in the lobby, while the National Guardsmen would carry the patients down the stairs. By 9:00 p.m., up to 30 patients were being evacuated each hour. The last ICU patient was transported out at 10:00 p.m. (Figure 8). The ICU staff, many of whom had been working for nearly 96 straight hours, erupted in applause, hugs, and tears of joy.
Evacuated patients were sent to receiving facilities with as much information as possible. As many computers were not reliably functioning during the evacuation, written notes were sent with some patients. Some of the patients with resistant TB were receiving second- and third-line medications. To avoid any interruptions in therapy, supplies of these medications were sent with the patients. In the hours following the evacuation, we learned that some patients arrived at receiving facilities without accompanying records and staff spent many hours ensuring that the accepting facilities had received adequate information to safely care for the evacuated patients. In the end, more than 700 patients were evacuated within 48 hours and no deaths or serious adverse events were reported.
Some things could have been done better. Although the vulnerability of the hospital’s power supply was recognized, the multiple other systems affected by flooding of the basement were not fully appreciated by ICU leadership. As such, we were not optimally prepared for interrupted communications, a limited water supply, a loss of central vacuum, or the loss of all elevator service.
Acknowledgement : Fully excerpted from https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201212-116OT
In its long history, Bellevue has survived natural disasters as well as blackouts, plane crashes, terrorist attacks, the height of the AIDS epidemic, and the associated resurgence of TB in the city. Before Superstorm Sandy, none of these events forced the evacuation or closure of the hospital.
In this context, one can imagine the significance of a storm that forced the hospital to evacuate and remain closed for several weeks. Although the size and strength of Superstorm Sandy were unprecedented, the outcome could have been much worse if the preparedness of the staff at Bellevue had not been tested and refined during Hurricane Irene, 1 year before Sandy.
Hurricane Irene approached New York in August 2011. Aside from the winds and rainfall, the main concern was the storm surge that could potentially flood parts of the city. Before the storm arrived, Manhattan was declared in a state of emergency, and mandatory evacuation of low-lying areas was ordered. Although the city’s hospitals were well prepared to accommodate victims of external disasters, this situation forced them to evaluate their readiness for flooding and possible loss of power.
Bellevue’s internal examination revealed that its power supply was its most significant vulnerability. If the hospital was to lose main power, it would depend on backup generator power. The generators, located on the 13th floor, would not be directly affected by flooding. However, the generator’s fuel pumps, located in the basement, would fail if submerged. This would result in a total loss of power to the hospital.
To address the vulnerability of the backup generator fuel pumps, they were encased within protective structures and sealed by submarine-style doors. This intervention would, it was thought, allow the pumps to continue functioning even if the basement flooded.
Sandy was expected to bring a storm surge of approximately 11 ft. As a reference, flooding would begin when the storm surge reached 6.7 ft.
In preparation for the storm and the planned suspension of public transit, many staff members, including ICU leadership, arrived before the storm. They came prepared to stay for the duration of the event.
At approximately 9:00 p.m., there was a brief loss of power, followed by a return of emergency lights and outlets. The hospital was now operating on generator power. Millions of gallons of water were rushing into the basement, which had been dry less than 2 hours earlier.
Although some elevator service should have remained while on generator power, water could be heard rushing into the elevator pits and all elevator service was lost.
Cell phone service was inconsistent, but landline telephones remained functional at that time.
At 10:00 p.m., the mechanisms protecting the generator fuel pumps failed. The pumps were now submerged, and all power would be lost when the generators ran out of fuel. This was likely to occur in the next two hours.
High-tide arrived at 10:30 p.m. and brought a massive 14-ft storm surge, well above the predicted 11-ft surge. The view from any window in the ICU revealed that the hospital was completely surrounded by water.
While we were working under the assumption that generator power would be lost, National Guard troops and hundreds of hospital staff members, ranging from hospital administrators to custodial workers, began carrying fuel from the ground up to the generators. They were able to form a continuous brigade, standing shoulder-to-shoulder up 13 flights of stairs. They passed the drums of fuel up to one final person, who carried the drum up a small ladder and poured it into the generator fuel tank. In the end, this brigade worked through the night and the following day and managed to supply the generators with enough fuel to last approximately 72 hours. This tremendous effort prevented the hospital from being thrown into total darkness, and protected countless patients from harm.
Soon after avoiding a power blackout, we suffered a communication blackout. Cellular networks were either damaged by the storm or overwhelmed with traffic. Our medical center e-mail server had gone offline. Hospital landlines, including the emergency phones, had been damaged by the flooding. Two-way radios had been distributed for emergency communications, but there were too few to handle such a massive coordinated effort. Essential information could be exchanged between the ICU and the command center only by sending messengers up and down 10 flights of stairs.
At midnight, because of the high likelihood that wall oxygen would be lost, National Guard troops began carrying H-cylinders of oxygen, each weighing 180 pounds, from the ground floor to the 10th floor. Many of these cylinders were carried up the stairs by teams of two National Guardsmen, providing a short-term supply of oxygen if central oxygen were to fail.
At daybreak on Tuesday, October 30, the view from the ICU confirmed that the rain had lightened, the wind had died down, and the floodwaters had begun to recede. Although it became easier to see what the storm had left behind, it became more difficult to see what lay ahead. Main power could not be restored in the near future and the generators were running on a limited supply of fuel. Without a reliable power source, we could not care for our patients indefinitely. Evacuation would be necessary. This enormous project would have to be achieved while conditions within the hospital were rapidly deteriorating. Vacuum power had been lost and patients were being suctioned via syringes attached to suction catheters. Food and water supplies were running low. Trash began filling the hallways. All 1,000 toilets could only be described as unusable, and staff members were forced to use bedside commodes in empty patient rooms. Many members of the hospital staff, despite these conditions and their concerns about their own homes and loved ones, chose to stay and assist with the evacuation.
The first patients to be evacuated, those on mechanical ventilators or requiring dialysis, were prepared for transport and carried downstairs by anyone willing to help. This included physicians, nurses, medical students, and ambulance crews. Although inspiring, the efforts were inefficient. Some patients, weighing as much as 185 kg, could only be carried by two teams of National Guard troops working in shifts and would require hours to successfully evacuate.
By midday on Wednesday, October 31, the conditions outside had greatly improved. News of our situation had spread, and ambulance crews poured in from all over the country. They represented Alabama, Colorado, Connecticut, Illinois, Louisiana, Michigan, Ohio, and many others. At the same time, more than 300 additional National Guard troops arrived to assist in the evacuation. With this additional help, the pace of the evacuation changed. The huge number of ambulance crews was able to mass in the lobby, while the National Guardsmen would carry the patients down the stairs. By 9:00 p.m., up to 30 patients were being evacuated each hour. The last ICU patient was transported out at 10:00 p.m. (Figure 8). The ICU staff, many of whom had been working for nearly 96 straight hours, erupted in applause, hugs, and tears of joy.
Evacuated patients were sent to receiving facilities with as much information as possible. As many computers were not reliably functioning during the evacuation, written notes were sent with some patients. Some of the patients with resistant TB were receiving second- and third-line medications. To avoid any interruptions in therapy, supplies of these medications were sent with the patients. In the hours following the evacuation, we learned that some patients arrived at receiving facilities without accompanying records and staff spent many hours ensuring that the accepting facilities had received adequate information to safely care for the evacuated patients. In the end, more than 700 patients were evacuated within 48 hours and no deaths or serious adverse events were reported.
Some things could have been done better. Although the vulnerability of the hospital’s power supply was recognized, the multiple other systems affected by flooding of the basement were not fully appreciated by ICU leadership. As such, we were not optimally prepared for interrupted communications, a limited water supply, a loss of central vacuum, or the loss of all elevator service.
Acknowledgement : Fully excerpted from https://www.atsjournals.org/doi/full/10.1513/AnnalsATS.201212-116OT
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