Lessons from Sandy — Preparing Health Systems for Future Disasters

Within hours after Hurricane Sandy’s landfall, doctors and staff at one of New York City’s premier medical centers realized that something was going terribly wrong. Lights were flickering, critical devices essential to life support for more than 200 patients, many in intensive care units, were malfunctioning. A decision had to be made by hospital leaders, senior public health officials, and emergency responders: tough it out in a hospital without power or attempt a perilous patient evacuation as an epic disaster unfolded. With little time to lose, the “go” order was given, followed by frantic calls to high-ground hospitals identifying beds for receiving New York University–Langone Medical Center’s critically ill patients. St. Luke’s–Roosevelt, Mt. Sinai, New York Presbyterian at Columbia, and many other hospitals responded immediately, opening beds, readying emergency admission procedures, and briefing staff. But questions about why these extreme measures were necessary will have to be answered in the months ahead. Although the first question may be how to prevent power failure, the nuances of backup and redundant power generation are not generally within the expertise of health professionals. And in fact, the generators themselves were probably fine; the problem appears to have been that fuel pumps supplying the generators were in the basement, highly susceptible to break- down from flooding. Ways of ensuring resiliency of backup power equipment will certainly be investigated later. For now, it’s important to understand what medical and public health challenges are to be expected after mega-disasters such as Hurricane Sandy.