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Abstract

Introduction: Nicknamed “Superstorm Sandy,” it is regarded as one of the deadliest, most destructive, and costly hurricanes of the 2012 Atlantic Hurricane Season. The storm struck the New York City on October 29th, 2012, “97 people died… thousands were displaced from their homes, and 2 major hospitals required perilous evacuations even as the hurricane-force winds engulfed the metropolitan region.”(2) Methods: One of the support centers was Lenox Hill Hospital (LHH), a 652-bed tertiary-care center, with 3 separate intensive care units each having 12 dedicated beds and additional 17 monitored step-down beds per unit. There are 8 full time intensivists and 6 fellows available 24 hours per day, 7 days a week. Emergency preparations at LHH began Thursday before the storm. Emergency Command Centers were activated; generators and other emergency equipment were tested. The hospital decanted to increase capacity with a pre-storm census of 397. Emergency teams were assigned, plans for medications and supplies were implemented, and transfer protocols activated. (1) LHH generally has a reserve of 26 invasive and 14 non-invasive ventilators. In preparation for Sandy, an additional 10 invasive and 5 non-invasive ventilators were rented increasing the reserve by 37.5%. Results: LHH received a total of 102 evacuees from surrounding hospitals, with the bulk, 83 patients coming from New York University (NYU) Langone Medical Center which was emergently shut down early Monday morning on October 29th. 62% of the NYU patients were admitted between 3 and 6 am, equaling 1 patient every 3 to 4 minutes. At that time all patients were admitted to LHH physician teams with limited patient information due to an inaccessible NYU electronic medical record system.(1) Due to the high volume of incoming patients and continued lack of functional facilities at NYU, a satellite office for credentialing was established. In the upcoming days, 315 NYU physicians and licensed independent practitioners were given Disaster Emergency privileges at LHH, over 700 NYU nurses were credentialed and oriented to LHH, and 160 NYU residents and fellows were added by the Office of Graduate Medical Education.(1) Conclusions: Intensive Care triage was performed in the Emergency Department upon arrival of evacuated patients by LHH Intensivist run teams and the units remained under LHH care personnel. Scheduled work hours were increased to allow availability of a fellow onsite at all times for critically ill patient management with a supervising intensivist. To accommodate the large flow of patients 1 chief and 2 supervising respiratory therapists took 48 hour call shifts alternately. Direct communication with the NYU healthcare staff was maintained and upon discharge from telemetry, transfer summaries were provided for each patient. The LHH pulmonary team fully incorporated their NYU counterparts. Two attendings and two fellows where emergently credentialed by the Medicine Board and seamlessly integrated into the bronchoscopy suite schedule. By prioritizing cases and rescheduling elective procedures, all cases were accommodated with ancillary support and cytological evaluation as needed. The Pulmonary consult services functioned independently; however, LHH pulmonary coverage was available for immediate assistance if the NYU staff was off site. After the storm, occupancy at LHH persisted from 99 to 107% with an average daily census of 493 to 550 patients. LHH transitioned to a 7 day a week operation performing operative elective procedures on Saturdays and Sundays.(1) BIBLIOGRAPHY: 1. Anthony Antonacci & Dennis Connors. “Executive Committee.” Presented on November 28, 2012. Microsoft PowerPoint File. 2. David Abramson & Irwin Redlener. “Hurricane Sandy: Lessons Learned, Again.” Disaster Medicine and Public Health Preparedness vol. 6; no. 4: 328–9. 3. Irwin Redlener & Michael J. Reilly. “Lessons from Sandy - Preparing Health Systems for Future Disasters.” New England Journal of Medicine 13 December 2012: 2269–71