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Curbside Consult with Dr. Jayne 11/5/12

November 5, 2012 Dr. Jayne 2 Comments

I’ve written before about the difficulty I sometimes have reconciling the high-tech tools I’m responsible for with the low-tech situations that physicians deal with on a regular basis. Many of us are confident we live in a wondrous age where innovation and technology are both the means and the end. Stories coming out of areas devastated by Hurricane Sandy, however, tell a different tale.

In New York City, the decision was made (based on storm predictions) to evacuate several hospitals prior to the storm, but not all. I don’t doubt that there was a lot of deliberation involved and careful weighing of the risks of evacuation vs. sheltering in place. New York has experience from Hurricane Irene and used that knowledge to inform its decision. Sometimes even the best plans go awry, as detailed in a New York Times article about the hospital situation.

As a physician (and as a first responder before medical school) I’ve been through my share of disaster drills. We don’t have hurricanes where I live, but we do have more than our fair share of fires, tornadoes, earthquakes, and floods. (Last year we even had locusts, but I digress.) I know in the event of an emergency what I’m supposed to do. I also count on hospital administrators and others to make good decisions.

Despite significant preparation, there were some misses in Bellevue’s disaster plan:

  • Although fuel pumps were in flood-resistant housings, they were in the basement, which flooded. Residents, nurses, and administrators ferried fuel up 13 flights of stairs to the backup generators.
  • Electrical control systems were also in the basement.
  • Elevator, oxygen supply, and water systems failed.
  • Disaster drills did not include actual practice of the scenario of carrying patients down the stairs to evacuate.

I cannot even fathom the conditions that caregivers and patients endured this week. And it wasn’t just at Bellevue. Speaking with some of my colleagues, conditions at several facilities were horrendous, with sanitation issues, sewage problems, and more. When evacuations were finally ordered, patients were carried or dragged down 10-15 flights of stairs, often with someone manually ventilating those patients who could not breathe on their own.

The Times article details the conditions at other hospitals. Patients were given minimal dialysis because private dialysis centers were closed. Facilities were only prepared to be on backup power for days rather than for a week or more. Food supplies ran low. Communication plans failed.

Due to a quirk of scheduling, I happened to be in the New York area this weekend. I am shocked by not only the devastation, but by the disparities across the region. New Yorkers are being urged to return to business as usual even though hundreds of thousands of people are without power and bodies are still being recovered. The devastation that occurred is a life-altering event for those affected. Psychologically, people need to grieve and come to terms with the past week rather than launch back into “business as usual.”

Not all of New York City was affected equally. Staten Island was hard hit, yet parts of Manhattan were relatively unscathed. A controversial decision was made by Mayor Michael Bloomberg to go ahead with the New York Marathon. Community advocates worried that emergency workers were already stressed by evacuations, fires, and rescues and that their efforts should be focused on rescue and recovery rather than recreation. Residents were furious that generators (albeit privately funded ones) were powering media tents when nearly half a million people were without power. Ultimately, Bloomberg responded to criticism by canceling the race Friday evening.

When this decision was announced, I was on a flight with a mix of marathoners and people who were returning home to the devastation. Conversation topics included everything from “what kind of generator should I buy for next time?” to lamentations of the race cancellation. I was surprised by the lack of empathy from runners/tourists who felt that New Yorkers had bullied the mayor into canceling. I hope their tone changed when they left the airport, because what I saw when I hit the roads was dramatic. Lines at gas stations were two to three hours long with significant power outages, lack of traffic signals, and many people who are still in shock.

It’s not over yet, however. This weather event and the subsequent tragedies will add to the healthcare burden not only in exacerbation of existing illness, but in a short term surge of respiratory, gastrointestinal, and other infectious complaints. In addition, there will be longer-term cases of post-traumatic stress disorder, anxiety, and depression.

Regional health authorities, hospitals, and disaster preparedness experts need to carefully learn from the events of this week and prepare their teams with careful planning and practice. Plenty of people were touting the benefits of HIEs to assist with natural disasters this week, but an HIE doesn’t do you a lot of good when you lack food, water, and basic sanitation. Does it really matter if the servers fail over gracefully if generator failure causes a hard stop a few hours later?

It seems that despite all our technology, people have become less prepared for events like this, as well as less resilient when they occur. In our post-Katrina world, people need to be ready to help themselves and not rely on government agencies. I urge each of you to use this as an opportunity to revisit your own personal disaster plans as well as those for your workplace. Emergency preparedness isn’t just for doomsday preppers, but should be for all of us.

No matter where you live, make an effort to have a week’s supply of food and water on hand (if nothing else, invest in some energy bars and a case of bottled water) and have a plan for where to go if you’re displaced from your home. You don’t have to be a secret agent to keep a “go bag” with a few clothes and essentials packed and in the closet or under the bed. Be aware of chronically ill or elderly relatives and neighbors. Ask them what their plans are and know whether you are willing to assist if the time comes. Know what your role would be if you are at work and disaster strikes. Be willing, be able, and be prepared.

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Currently there are "2 comments" on this Article:

  1. Bravo, Dr. Jayne! This was the best article I’ve read on the Hurricane (and you’ve ever written) and I especially appreciated your suggestions on preparedness at the end. Perhaps we should have a national marketing campaign similar to reminding people to check the batteries in their smoke detectors each October. We need to educate and remind people what preparedness actually means!

  2. Another thing to put in the bag is a copy of your homeowner’s insurance, driver’s license, passport, health insurance card, etc. any important papers. I always thought it was a travesty that the insurance companies made money during the year of Katrina and I’m sure NY, NJ policy holders will get the same treatment in the very near future. I wish all of them the best of luck.







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