Hospitals pride themselves on being prepared for all sorts of emergencies. But not even the best-laid plans can ready an institution and its staff for an unprecedented event. That’s what Tisch Hospital at NYU Langone Medical Center faced when Hurricane Sandy forced unplanned evacuations after the facility lost power.

“I’m not a dramatic guy,” said Joseph D. Zuckerman, MD, professor and chair of the department of orthopaedic surgery at NYU Langone. “But I’ll tell you, the effort to evacuate this hospital was nothing short of heroic.”

According to Dr. Zuckerman, the story began on Thursday, Oct. 25—the day Hurricane Sandy struck the Bahamas, with the National Weather Service tracking its path. According to forecasters, Sandy was headed for the northeastern Atlantic coast of the United States, with all the potential for being a “perfect storm.”

“In anticipation of the hurricane, the hospital began to discharge all appropriate patients,” said Dr. Zuckerman. “From Friday through Sunday, the hospital census went from more than 500 patients to about 325. We canceled the operating room schedules for Monday. We didn’t evacuate, because the city and state had made the determination that evacuation probably wouldn’t be necessary.

“On Monday morning I came to work as usual, and I went home around midafternoon. The weather was getting bad, and I wanted to make sure things were okay.”

An unprecedented storm
A bit of history: The largest storm surge in New York City history was 11.2 feet; it happened in 1821 during the Norfolk and Long Island Hurricane.

“Almost 200 years ago,” Dr. Zuckerman emphasized.

The medical center was built to withstand a storm surge of 13 feet—2 feet higher than the historic maximum.However, when Sandy struck, the surge at the southern point of Manhattan reached 13.8 feet. Even that may not have been a problem, but for the physics of the water surrounding the island.

“The storm forced the water up the East River, against the normal flow of the river, and the two water masses converged right at the Medical Center,” said Dr. Zuckerman. “At that point, the surge was estimated to have reached between 14 and 16 feet. Right in the heart of New York City.”

At about 7 p.m. on Monday night, the electrical grid went down, leaving the hospital on emergency generator power.

“That in and of itself is a significant event,” explained Dr. Zuckerman. “But we prepare for such things. There are generators located on the roof, powered by fuel lines from tanks down at grade level. For a few hours, everything worked the way it was supposed to. Essential patient care functions were on generator power and everything was fine.”

But the storm surge had forced a tremendous amount of water—as much as 7 million gallons according to one estimate—into the basement and subbasement of the medical facility. The water disrupted the fuel tanks and the fuel lines, and within hours, the emergency generators failed.

“When the word got out that Tisch Hospital had to be evacuated, it was all hands on deck; medical students, faculty physicians, residents, non-physician members of the staff, even some physicians from other institutions came in to assist,” said Dr. Zuckerman. “Police and fire crews showed up as well, not only to provide ambulances but to hold lights and doors and to help carry patients.”

Over the next 12 to 14 hours, more than 300 patients, many of them critically ill—including one 8-hour old premature baby—were evacuated from the hospital.

“Keep in mind that Tisch Hospital is a tower,” continued. Dr. Zuckerman. “You’re evacuating a building where patients could be on the 17th floor, with no elevators and no lights. Patients had to be carried manually down stairways. Some would have been on respirators, but without power, staff had to provide manual ventilation as they were taking the patients down. It was a tremendous, tremendous effort.”

Transformation
According to Dr. Zuckerman, the orthopaedics department, which is based a few blocks away at the Hospital for Joint Diseases (HJD), survived the storm with less damage than other departments.

“We were on generator power all week, until Friday night,” he said. “Some of the staff were here for 6 days straight because they couldn’t get home, but we were able to treat our patients and discharge them when appropriate.”

In the aftermath of the storm, HJD took on a new role. With damage remaining at Tisch, physicians at HJD shared resources and provided office space and operating facilities. At the time of this writing, operations were being performed at HJD 7 days a week, with most of the weekend surgeries being nonorthopaedic.

“We’ve been working with all aspects of the medical center,” said Dr. Zuckerman. “They’ve done an incredible job under adverse conditions to get faculty office practices up and running and people moved to other locations. That’s what you have to do at times like this—use the resources you have.”

Amid all the damage, Dr. Zuckerman sees some positives.

“Everything here now is in the recovery phase. We had already begun a $3 billion campus transformation, and for two reasons, it’s likely that project will be accelerated. First, we have the opportunity to do it now, and second, updates are planned that will make us more independent of the weather.

“We’ve begun working more closely with members of other departments, particularly the surgical departments, but nonsurgical departments as well, to make sure that they can do their clinical activity here,” he continued. “For instance, pediatric patients who need to get chemotherapy treatments are now receiving them at HJD.”

Finally, Dr. Zuckerman points to a simple, seemingly inconsequential lesson learned that could alter the way future crises are handled.

“Everyone on staff has a facility email address, and that’s a primary line of communication,” he said. “But when the power went out, our email system was knocked out for 2 days. So when the power came back, the first thing we did was to collect an alternate email address for everyone, to make sure we can contact them in an emergency.”

Even better than before
“We were very fortunate in orthopaedics because our clinical activities are 90 percent intact, but, at the same time, we have a great sense of responsibility to do whatever is necessary—to be what I like to call ‘citizens of the medical center’—and make sure we provide resources, assistance, anything we possibly can, to get the medical center back where it needs to be and in a way that’s going to make us even better than we were before,” said Dr. Zuckerman.

“I can’t say that what we’ve gone through is anything like what New Orleans had to deal with during Katrina,” he continued. “But it gives you perspective. You realize that, although you followed every code requirement for weather events like this and then some, you have to plan for even more than that, because that’s what happened here.”

Peter Pollack is a staff writer for AAOS Now. He can be reached at ppollack@aaosnow.org