Irene as teacher

Lessons learned com­bat­ing East Coast hur­ri­cane ap­ply else­where

Modern Healthcare - - Opinions Commentary - Lee Perl­man and Su­san Walt­man Editor’s note: The full ver­sion of this commentary, with additional pho­tos, is avail­able at modern­health­

Near mid­night on Fri­day, Aug. 26, as Hur­ri­cane Irene men­aced North Carolina on its way to New York City, NYU Lan­gone Med­i­cal Cen­ter made an ur­gent call to the Greater New York Hos­pi­tal As­so­ci­a­tion’s desk at the city’s Of­fice of Emer­gency Man­age­ment. One of seven hos­pi­tals or­dered evac­u­a­tion in ad­vance of the hur­ri­cane, NYU Lan­gone des­per­ately needed to lo­cate beds for three ex­tremely ill in­ten­sive-care unit pa­tients.

Lack­ing nearby op­tions—hos­pi­tals across the re­gion had been tak­ing in evac­u­ated pa­tients and were at ca­pac­ity—GNYHA called Hart­ford Hos­pi­tal CEO Jef­frey Flaks at home, and the former New York hos­pi­tal ex­ec­u­tive 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 in Con­necti­cut.

Hart­ford’s no-ques­tions-asked re­sponse mir­rored the heroic ef­forts of hos­pi­tals and health sys­tems that en­abled New York’s health­care com­mu­nity to over­come im­mense lo­gis­ti­cal chal­lenges and safely evac­u­ate 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 as travel be­came more dan­ger­ous, it looked as if some evac­u­a­tions would not be com­pleted. But a re­lent­less “can do” at­ti­tude, prob­lem solv­ing, tremen­dous com­mu­ni­ca­tion and co­op­er­a­tion be­tween hos­pi­tals and govern­ment agen­cies, timely lead­er­ship and a strong emer­gency pre­pared­ness in­fra­struc­ture proved de­ci­sive.

Per­haps most im­por­tant, we learned. We worked around the clock for nearly six days and took away lessons that can be ap­plied else­where.

While 9/11 re­de­fined hos­pi­tal emer­gency pre­pared­ness across the na­tion, GNYHA has al­ways de­voted sig­nif­i­cant re­sources to our hos­pi­tals’ pre­pared­ness in­fra­struc­ture and to en­sur­ing that an “all haz­ards” ap­proach en­ables them to re­spond to a wide range of emer­gen­cies. So when Irene emerged as a threat, we were ready.

Days be­fore Irene’s ar­rival—and be­fore Mayor Michael Bloomberg is­sued his “Zone A” evac­u­a­tion cov­er­ing five hos­pi­tal sites and nearly a dozen nurs­ing homes (sev­eral fa­cil­i­ties on the Rock­away Penin­sula were later 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. GNYHA helped sev­eral hos­pi­tals ful­fill needs they iden­ti­fied be­fore Irene’s ar­rival, such as sand­bags, cots, a back-up gen­er­a­tor, emer­gency light­ing, sheets, tow­els and blan­kets.

We were re­minded of the tremen­dous value of easy-to-read check­lists, and that there’s no such thing as too much prepa­ra­tion.

No emer­gency fol­lows a script. The evac­u­a­tion or­der forced GNYHA and its mem­ber hos­pi­tals to ad­just on the fly to fa­cil­i­tate the safe 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 clus­tered hos­pi­tals are usu­ally re­garded as com­peti­tors, it was in the spirit of col­lab­o­ra­tion that hos­pi­tals such as the bustling Kings­brook Jewish Med­i­cal Cen­ter in Brook­lyn boldly took in more than 200 evac­u­ated pa­tients, and the North Shore-Long Is­land Jewish Health Sys­tem did the same for Staten Is­land Univer­sity Hos­pi­tal and sev­eral oth­ers. In the process, we learned that hos­pi­tals must be open to us­ing non­tra­di­tional space for evac­uees and must have plans for their care­givers to ac­com­pany pa­tients when they are evac­u­ated.

True lead­ers “lead from the front,” as demon­strated by state health Com­mis­sioner Dr. Ni­rav Shah, city health Com­mis­sioner Dr. Thomas Far­ley and OEM Com­mis­sioner Joseph Bruno. Their hands-on lead­er­ship at OEM head­quar­ters set an ex­am­ple that GNYHA, and the hos­pi­tal com­mu­nity fol­lowed. Shah called hos­pi­tals at the height of the evac­u­a­tions to en­cour­age their tired, anx­ious staffs to keep up their great work. He also gave hos­pi­tals the au­thor­ity to ex­ceed their op­er­at­ing cer­tifi­cate ca­pac­ity and take on more evac­uees.

Like the ur­gent call to Hart­ford, the power of re­la­tion­ships paid im­mense div­i­dends. In just one of many ex­am­ples, when OEM needed food for an evac­u­a­tion shel­ter, GNYHA’s busi­ness sub­sidiary, GNYHA Ven­tures, called its long­time busi­ness part­ner U.S. Food­ser­vice, which supplied to the shel­ters in less than eight hours.

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 help our fel­low hos­pi­tals to meet the chal­lenge.

GNYHA staff, with lo­cal and state health of­fi­cials, work at New York City’s Of­fice of Emer­gency Man­age­ment dur­ing Hur­ri­cane Irene.

Lee Perl­man and Su­san Walt­man are ex­ec­u­tive vice pres­i­dents of the Greater New York Hos­pi­tal As­so­ci­a­tion.

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