Storm Damage: When Patients Must Be Moved
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The hospital, which rises alongside the East River at 1st Avenue and E. 33rd Street, had an inpatient census of 215 when the lights went out and the decision was made to evacuate all patients, according to news reports that quoted hospital spokesperson Lorinda Klein.
The patients, carried or helped down from as high as the 17th floor, were transported to neighboring hospitals that included Mount Sinai and Memorial Sloan Kettering Cancer Center.
As of midday Tuesday MedPage Today's attempts to reach NYU officials were unsuccessful.
"It is every hospital's nightmare -- evaluating whether the risk of moving your most vulnerable patients outweighs the risk of sheltering in place. It sounds like NYU made the right decision, hats off to them."
That's how emergency physician Julliette Saussy, MD, summed up the NYU decision.
In the world of natural disasters, Saussy is the voice of experience -- she served as director of emergency services for New Orleans when Hurricane Katrina devastated that city in 2005.
Asked by MedPage Today to review the likely issues faced by NYU, she said evacuations "become a balancing act when you are faced with a storm [like Hurricane Sandy]."
Typically, in the days preceding a storm hospitals will begin discharging "anyone that you can discharge, but those that are left are usually the most vulnerable," she said.
Moving the babies
Among those most vulnerable are infants in the neonatal intensive care unit.
According to news reports, NYU evacuated about 20 babies making this evacuation one of the "largest NICU evacuations," said F. Sessions Cole, MD, director of the division of newborn medicine at Washington University in St. Louis School of Medicine Children's Hospital.
A number of factors make such evacuations especially problematic, including the need to maintain body temperature in tiny patients who cannot adequately control their own.
Any move away from a heat source and causing a drop in body temperature is dicey, he said, noting that NICU patients "have much lower biologic reserves to respond to stress."
Cole had nothing but praise for the NYU evacuation noting that it takes an average of three people to evacuate each baby on life support, saying "they absolutely did a great job."
At NYU, the babies were evacuated "in the dark and they needed to be carried down stairs, which means that two more people were needed to carry the incubator while the other three monitored life support systems and medications," Cole explained.
About 20 years ago, Cole was faced with a similarly daunting situation when a fire in another part of the hospital forced him to evacuate 55 NICU patients.
But he had the advantage of working with the power on and timing was on his side: the evacuation occurred around 7:30 in the evening "when many of our NICU parents were in the unit" which made parental notification easier.
Parents, Cole said, not only need to be informed about the reason for the evacuation and given information about where their babies are being sent, but they also need to told about the baby's condition.
On a crowded island
NYU has the advantage of being on an island that it shares with many other hospitals, but that geographic proximity may itself pose a problem "when you have power failure throughout a grid, that means that the neighboring hospitals are also relying on backup power, using systems that may already be stressed," Saussy said.
Another Katrina veteran, Norris Yarbrough, assistant vice president of emergency preparedness and response for the eight-hospital Ochsner Health System, echoed Saussy's cautions about emergency power systems.
Without knowing the exact circumstances at NYU, Yarbrough said it may have faced a situation similar to what happened at Ochsner during Katrina -- emergency generators bolted to concrete slabs where they could be in harm's way when the slabs are located in basements or other areas that could easily flood.
Ochsner, which was the only New Orleans hospital system that remained open during Katrina, lost one of its three emergency generators that way. But since Katrina, the hospital has installed its generators on flatbed trailers so they can be moved out of the path of flood waters.
Paul Pepe, who heads emergency services at UT Southwestern in Dallas, agreed that location of generators is critical. Noting that while basements pose a risk when flooding, putting generators on top of buildings may also be problematic.
"If tornadoes or high winds are an issue, up high is not the answer," he said.
Pepe said that the power needs to be in core areas where it can be secure, something that healthcare facility designers are now taking into consideration when designing hospitals.
Making generators truly portable was just one of the lessons learned from Katrina, Yarbrough said.
"Another was what the power feeds -- it is not just about outlets and lights. It is important to be sure that the generators are feeding the air circulating systems," he said.
Saussy, who now teaches at Lousiana State University and works for the maker of emergency medical devices, agreed that was a major issue during Katrina when temperatures soared and hospitals that did have power didn't have power for air conditioning.
October in Manhattan doesn't pose an air conditioning dilemma but "circulating air in closed areas such as operating rooms that can get stuffy" needs to be taken into consideration.
Finally, Saussy said, evacuation poses logistical problems for staff, families of staff, and the families of patients.
"Following patients after they have left your facility, as well as planning for support of staff -- for example how will you feed them and house them? -- as well informing patients' families of the relocated patients" are all challenges that add another layer of stress, she said.
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