Lessons Learned From Hurricane Sandy: 6 Steps Every Hospital Should Implement Before Disaster Strikes

While many hospitals, especially in New Jersey and New York, evacuated or took precautions in advance of Hurricane Sandy in October 2012, others were caught off guard. Extensive damage to residential and commercial properties from flooding and storm surge left millions of people along the entire East Coast without shelter and power. The unprecedented storm forced the closure of hospitals, nursing homes and healthcare facilities for prolonged periods of time.

As medical professionals, there is no more critical time to "put on our white coats" as during an emergency or natural disaster. Therefore, it must be clearly and emphatically communicated to hospital senior leadership and management what is expected of the clinical and support staff well before any emergency. Advanced planning puts emphasis on several best practices that any hospital or healthcare facility can emulate and implement.

As Hurricane Sandy approached the Middle Atlantic, Northeast and New England regions, our organization activated our crisis management team and disaster preparation model. We successfully sent more than 1,000 anesthesiologists, nurse anesthetists and clinicians and 225 administrative staff to 38 hospitals and healthcare facilities in the affected regions.

Here are six measures that we had intact and fully operational long before Superstorm Sandy. In fact, we upgraded some of our approaches immediately following another storm, Hurricane Irene, which hit many of the same areas in August 2011.

These six "common sense" approaches made providing coverage to our client hospitals and other health facilities easier, safer and more thorough.

1. Prepare at home and the workplace. As medical professionals, we are responsible for our patients and accountable for actively participating in ongoing safety and emergency protocols. However, being prepared is not exclusive to the workplace. Clinical staff, especially hospital leaders, should apply the same safety principles and advanced preparation to secure their homes and families in advance, as well.

During a real emergency, advanced planning pays off and provides peace of mind. When the staff has already taken care of their personal matters, they can safely report to the work site, perform their duties and ultimately care for patients for the duration of the event with minimal distractions.

2. Plan for early arrival. We communicated widely what was expected during Hurricane Sandy. Staff arrived well in advance to stay at the hospital, even if they were not on active duty. Most brought personal items and planned for getting rest or sleep between shifts. We found that it is well worth the time and money to have staff arrive as early as possible, as opposed to waiting until the last minute to mobilize. In the future, we plan to be more proactive about reserving large blocks of hotel rooms close to the hospitals to better accommodate staff.

3. Plan to deploy staff in unconventional ways. During Sandy, hospitals in the storm's direct path or in flood zones were notified of the availability of our staff for more than anesthesia-related purposes and to compensate for shortages of medical staff. In the past, anesthesiologists functioned only in the operating room, but those days are gone.

As trained emergency response professionals, anesthesiologists and CRNAs can adapt to any clinical situation and can deal with varied situations anywhere in the hospital and at any time. This same concept applies to other disciplines. Staff can cover the intensive care unit or the emergency room or serve as house physicians on patient floors. Clinical staff can manage pain issues or take care of patients with shortness of breath, blood sugar spikes or provide other routine care.

4. Invest in state-of-the-art communications technology.
During any storm or other emergency, no one knows what form of communication will go down or become spotty at different times and places. Inevitably, disruptions occur with telephones, cell phones, the Internet and mobile devices. After Hurricane Irene in 2011, our organization re-evaluated and upgraded our emergency communications system, similar to what many school districts and universities, cities and townships use across the United States.
We purchased a geographically based, high-speed emergency notification system through Twenty First Century Communications. The system reaches thousands of people simultaneously with specific, up-to-the-minute messaging sent to land lines, cellular telephones, computers, fax machines, pagers and other devices. It streamlines processes and alleviates the use of administrative staff, which would otherwise need to make time-consuming telephone calls that are less than efficient and optimal. With the new system, everyone gets the same or customized messages in a swift and cohesive manner.

5. Establish mandatory brainstorming sessions throughout the year with senior hospital leadership. Make emergency management a top priority. After investing in the global communications system, all hospital and departmental chiefs were required to train on the new system and customize their contact lists for hospital-specific messaging. These were downloaded into the new system before Hurricane Sandy. As a result, it was relatively easy to triage from the central command center and send messages to 1,500 people. In addition, we regularly meet throughout the year to strategize on quality improvement, including emergency management.

6. Volunteer at the Emergency Operations Center. Every hospital's EOC needs backup during actual emergencies. Anesthesiologists and other physicians can be an important part of an EOC because we understand how each part of the hospital works. It's imperative to provide support to a hospital's chief medical officer or executive director to give breaks and allow for rest time because the EOC runs for days and around the clock. Staff should be instructed to physically show up at the EOC and offer support, such as answering telephones or solving unforeseen problems, during any emergency event.

Hurricane Sandy caused other problems that hadn't been an issue during previous storms. For example, we accepted patients from evacuating hospitals during Hurricane Irene and returned these patients to their hospitals or nursing homes after the storm passed. But, during Hurricane Sandy, numerous facilities were not operational for weeks and months. As a result, many surgeons and physicians had no place to work. We not only provided for evacuated patients and staffing shortages, but we also expedited clinical privileges to displaced medical staff at our facilities that were either unaffected by the storm or fully operational and accepting patients.

John Di Capua, MD, serves as deputy CEO and chief medical officer for North American Partners in Anesthesia, based in Melville, N.Y. He is the Peter F.R. Walker associate professor and chairman of the department of anesthesiology at North Shore University Hospital, Long Island Jewish Medical Center and Hofstra-NSLIJ School of Medicine. 

More Articles on Hospital Disaster Preparations:

5 Steps to Prevent Infection After Hospital Flooding
Weathering the Storm: How to Prepare for Severe Weather Emergencies

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