The business of healthcare operates 24 hours a day, seven days a week, 365 days a year. When initial weather reports indicated that the New York City region was in Hurricane Sandy's path, GNYHA Ventures and our parent organization, the Greater New York Hospital Association, took our place at the New York City Office of Emergency Management Healthcare Evacuation Center and began helping hospitals and nursing homes prepare for the worst. But despite those pre-storm preparations, no one could have predicted Sandy's ultimate strength and its consequences — especially the emergency evacuations of thousands of hospital patients and long-term care residents.
What transpired before, during and after Hurricane Sandy was a remarkable display of the healthcare community, local first responders, and numerous city, state and federal agencies coming together to ensure the safe continuity of care for New York's patients and long-term care residents. While recovery continues throughout the region, we have begun reflecting on lessons that were learned during the storm.
First and foremost, the goal of any healthcare facility during severe weather is to avoid evacuating unless absolutely necessary. We learned in the days before the storm that one utility company was debating a preemptive shutdown of portions of its grids in lower Manhattan to avoid major equipment damage if a storm surge — the rise of water beyond what would be expected by the normal movement due to tides — occurred. We began contacting members that would be affected by preemptive shutdown to gauge their ability to operate should it occur. One hospital decided to fully evacuate in anticipation of the power outage and the potential for severe flooding. Others began preparing to "shelter in place"by testing their generators, moving patients to higher floors and ensuring they had necessary supplies to get them through the storm.
Once Sandy made landfall over the area, it quickly became apparent that it was going to be a much stronger storm than predicted. While facilities in the region's low-lying, flood-prone areas had prepared for the predicted storm surge, the actual surge proved to be far more devastating, forcing more than a dozen hospitals, nursing homes and adult day care facilities to evacuate during and in the days after Sandy.
These developments reminded us once again that testing backup generators on a regular basis and in the immediate days before a storm is a critical emergency preparedness element. Sandy taught us that in addition to testing, facilities should evaluate the placement of backup generators and other necessary equipment. Depending on the type of risk you face, the building's basement or the very top level may not necessarily be the best locations. If feasible, consider the possibility of storing multiple generators in different locations.
You also need to consider the ability to fuel that generator for multiple days after the storm has passed. You may have weathered the storm, but the damage in your area may be so great that power to your facility may be disrupted for days or weeks. Finally, it is recommended that you have a plan in place to quickly access another generator through your supplier if your generator is damaged during the storm.
During the worst of Sandy and for days after, cell phone service throughout the region was spotty at best. Getting in touch with our key contacts at facilities became challenging and reminded us of how reliant we've become on instant communication, thanks to technology that allows us to text, check e-mail, and browse the Internet on our smart phones.
The ability to communicate with first responders, government agencies, and other healthcare facilities is essential during an emergency. When preparing your master contact list of emergency key contacts, ensure that multiple copies of the list are printed out in advance (your printers won't work if you lose power) and include cell phone and landline numbers. You may not be able to avoid spotty communication, but you can have as many numbers as possible at your fingertips, especially if you are in danger of needing to evacuate patients, or in need of emergency supplies to keep your facility functioning.
How often do you stop and think about your supply chain when preparing for a potential weather emergency? Since your supply chain staff will be your point of contact with vendors to arrange for delivery of necessary supplies before, during and after a weather event like Hurricane Sandy, they must be a critical part of your emergency preparedness team.
Sandy brought such destruction to certain neighborhoods that vehicle access was challenging, if not impossible. Closed ports of entry temporarily stopped the delivery of desperately needed fuel and pharmaceutical supplies. And when travel restrictions were imposed to ease congestion as mass transit slowly came back online, it was extremely difficult for delivery vehicles and healthcare workers to get in and out of New York City.
We advise that facilities prepare to "shelter in place" to prepare for worst case scenarios. You should have enough essential supplies on hand to last a minimum of 72–96 hours after a storm. Those supplies include non-perishable food, pharmaceuticals, clean linens and cots or air mattresses for staff. Facilities should also include adequate supplies of diesel fuel to their "critical supply" list.
Your group purchasing organization is also a critical component of your first response team. The GPO mission — delivering the right products to the right patients at the right time — becomes more critical when trying to ensure continuity of care during an emergency. When Sandy made it difficult for facilities to communicate with their suppliers, we used our network of manufacturers and distributors to ensure that necessary supplies were delivered.
If your local supplier cannot deliver because its warehouse was compromised, or because demand for supplies increases during emergencies, your GPO can tap into its vast network to locate what you need and arrange for it to be delivered as quickly as possible.
A crisis often brings out the best in people, and the healthcare community is no different. Despite enormous challenges, many hospitals and long-term care facilities saw little or no disruption to their patient care and stepped up to accept patients from evacuated facilities. Others shared precious resources while not knowing when their own supplies would be replenished.
For the facilities that did have to evacuate, there were many elements that contributed to so many hospital patients and nursing home residents being moved without a single adverse event occurring. One was an incredible amount of cooperation and collaboration among the entire healthcare community, as well as public and private agencies at all levels.
Another element was the enormous amount of work that is done by dedicated teams of people who communicate year-round. Having a strong emergency preparedness plan already in place before severe weather or other emergencies occur is truly "half the battle." Constant communication between your facility's core team and the outside agencies and entities who will be your partners during emergencies is crucial to any successful plan. Your plan should be regularly updated as you learn from your own experiences and the experiences of others.
Adhering to the three Cs — cooperation, collaboration, and communication — will help to ensure you are prepared when an emergency such as Hurricane Sandy strikes. Possibly the most important lesson learned during and after Sandy is that not only is a back-up plan essential, but having a back-up to the back-up plan will inevitably help your facility better respond to emergencies.
Christopher J. O'Connor is executive vice president of GNYHA Ventures, Inc., the for-profit arm of the Greater New York Hospital Association, and president of two GNYHA Ventures companies: GNYHA Services, an acute-care group purchasing organization, and Nexera, a healthcare consulting firm. Mr. O'Connor is chair-elect of the Association for Healthcare Resource & Materials Management.
What transpired before, during and after Hurricane Sandy was a remarkable display of the healthcare community, local first responders, and numerous city, state and federal agencies coming together to ensure the safe continuity of care for New York's patients and long-term care residents. While recovery continues throughout the region, we have begun reflecting on lessons that were learned during the storm.
First and foremost, the goal of any healthcare facility during severe weather is to avoid evacuating unless absolutely necessary. We learned in the days before the storm that one utility company was debating a preemptive shutdown of portions of its grids in lower Manhattan to avoid major equipment damage if a storm surge — the rise of water beyond what would be expected by the normal movement due to tides — occurred. We began contacting members that would be affected by preemptive shutdown to gauge their ability to operate should it occur. One hospital decided to fully evacuate in anticipation of the power outage and the potential for severe flooding. Others began preparing to "shelter in place"by testing their generators, moving patients to higher floors and ensuring they had necessary supplies to get them through the storm.
Once Sandy made landfall over the area, it quickly became apparent that it was going to be a much stronger storm than predicted. While facilities in the region's low-lying, flood-prone areas had prepared for the predicted storm surge, the actual surge proved to be far more devastating, forcing more than a dozen hospitals, nursing homes and adult day care facilities to evacuate during and in the days after Sandy.
These developments reminded us once again that testing backup generators on a regular basis and in the immediate days before a storm is a critical emergency preparedness element. Sandy taught us that in addition to testing, facilities should evaluate the placement of backup generators and other necessary equipment. Depending on the type of risk you face, the building's basement or the very top level may not necessarily be the best locations. If feasible, consider the possibility of storing multiple generators in different locations.
You also need to consider the ability to fuel that generator for multiple days after the storm has passed. You may have weathered the storm, but the damage in your area may be so great that power to your facility may be disrupted for days or weeks. Finally, it is recommended that you have a plan in place to quickly access another generator through your supplier if your generator is damaged during the storm.
During the worst of Sandy and for days after, cell phone service throughout the region was spotty at best. Getting in touch with our key contacts at facilities became challenging and reminded us of how reliant we've become on instant communication, thanks to technology that allows us to text, check e-mail, and browse the Internet on our smart phones.
The ability to communicate with first responders, government agencies, and other healthcare facilities is essential during an emergency. When preparing your master contact list of emergency key contacts, ensure that multiple copies of the list are printed out in advance (your printers won't work if you lose power) and include cell phone and landline numbers. You may not be able to avoid spotty communication, but you can have as many numbers as possible at your fingertips, especially if you are in danger of needing to evacuate patients, or in need of emergency supplies to keep your facility functioning.
How often do you stop and think about your supply chain when preparing for a potential weather emergency? Since your supply chain staff will be your point of contact with vendors to arrange for delivery of necessary supplies before, during and after a weather event like Hurricane Sandy, they must be a critical part of your emergency preparedness team.
Sandy brought such destruction to certain neighborhoods that vehicle access was challenging, if not impossible. Closed ports of entry temporarily stopped the delivery of desperately needed fuel and pharmaceutical supplies. And when travel restrictions were imposed to ease congestion as mass transit slowly came back online, it was extremely difficult for delivery vehicles and healthcare workers to get in and out of New York City.
We advise that facilities prepare to "shelter in place" to prepare for worst case scenarios. You should have enough essential supplies on hand to last a minimum of 72–96 hours after a storm. Those supplies include non-perishable food, pharmaceuticals, clean linens and cots or air mattresses for staff. Facilities should also include adequate supplies of diesel fuel to their "critical supply" list.
Your group purchasing organization is also a critical component of your first response team. The GPO mission — delivering the right products to the right patients at the right time — becomes more critical when trying to ensure continuity of care during an emergency. When Sandy made it difficult for facilities to communicate with their suppliers, we used our network of manufacturers and distributors to ensure that necessary supplies were delivered.
If your local supplier cannot deliver because its warehouse was compromised, or because demand for supplies increases during emergencies, your GPO can tap into its vast network to locate what you need and arrange for it to be delivered as quickly as possible.
A crisis often brings out the best in people, and the healthcare community is no different. Despite enormous challenges, many hospitals and long-term care facilities saw little or no disruption to their patient care and stepped up to accept patients from evacuated facilities. Others shared precious resources while not knowing when their own supplies would be replenished.
For the facilities that did have to evacuate, there were many elements that contributed to so many hospital patients and nursing home residents being moved without a single adverse event occurring. One was an incredible amount of cooperation and collaboration among the entire healthcare community, as well as public and private agencies at all levels.
Another element was the enormous amount of work that is done by dedicated teams of people who communicate year-round. Having a strong emergency preparedness plan already in place before severe weather or other emergencies occur is truly "half the battle." Constant communication between your facility's core team and the outside agencies and entities who will be your partners during emergencies is crucial to any successful plan. Your plan should be regularly updated as you learn from your own experiences and the experiences of others.
Adhering to the three Cs — cooperation, collaboration, and communication — will help to ensure you are prepared when an emergency such as Hurricane Sandy strikes. Possibly the most important lesson learned during and after Sandy is that not only is a back-up plan essential, but having a back-up to the back-up plan will inevitably help your facility better respond to emergencies.
Christopher J. O'Connor is executive vice president of GNYHA Ventures, Inc., the for-profit arm of the Greater New York Hospital Association, and president of two GNYHA Ventures companies: GNYHA Services, an acute-care group purchasing organization, and Nexera, a healthcare consulting firm. Mr. O'Connor is chair-elect of the Association for Healthcare Resource & Materials Management.
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