* Emergency preparedness usually focuses on surge of
patients
* Hospitals almost never hold drills for own emergencies
* New equipment to ensure operations in disasters is
expensive
By Sharon Begley
NEW YORK, Nov 3 (Reuters) – Kim Bondy was in New Orleans
seven years ago when Hurricane Katrina devastated the city, and
scores of patients died in flooded hospitals cut off from power.
She never thought that she might face that danger herself.
But on Monday night, as superstorm Sandy submerged parts of
New York City, Bondy was one of 215 patients evacuated from New
York University’s Langone Medical Center after basement flooding
from the East River cut off its electricity.
“Knowing everything that happened in New Orleans hospitals,
I’m thinking, ‘I am not going to be that story,'” said Bondy,
46, a New Orleans resident who was hospitalized in New York over
the weekend with a blocked intestine. “Did you not pay attention
to what we learned from Katrina?”
The equipment failures at NYU and nearby Bellevue Hospital,
the nation’s oldest and one of its busiest, brought to the fore
what emergency experts have warned for years. Despite bitter
lessons from the recent past, U.S. hospitals are far from ready
to protect patients when disaster strikes their facilities.
“I’ve been asking hospitals to look at their own
survivability” after a natural or manmade disaster, “and I just
can’t get it on their radar screens,” said Dr. Art Kellerman, an
expert in emergency preparedness in healthcare at the RAND Corp.
“If you asked me the one city in America that has its act
together, I would have said New York. That tells you how much
trouble we’re in in Dayton and Detroit and Sacramento.”
For most hospitals, “emergency preparedness” means being
ready to treat a surge of patients from an earthquake or terror
attack – disasters outside their walls. Even the federal program
that coordinates hospitals’ preparedness at the Department of
Health and Human Services has this mindset: it focuses on
planning for mass fatalities and quickly reporting their number
of available beds, not having redundant electrical systems.
When the next Katrina or Sandy strikes, “we’re going to have
the same problems,” warned a scientist who has led studies on
hospital preparedness at a leading research institution. He
asked not to be named so as not to antagonize hospital officials
and others he works with.
For hospital administrators trying to keep their
institutions in the black, disaster-resistant infrastructure is
expensive and lacks the sex appeal of robotic surgery suites and
proton-beam cancer therapy to attract patients.
“People don’t pick hospitals based on which one has the best
generator,” Kellerman said.
UNWILLING TO INVEST
A recent survey by the Joint Commission, a nonprofit group
that accredits more than 19,000 hospitals and other healthcare
facilities, found that only one-third planned to upgrade their
infrastructure, said head engineer George Mills.
“Two-thirds said they were going to keep going with what
they had and hope it was enough,” he said. “Unfortunately, many
of our hospital buildings are 50 or 60 years old.”
No national assessment has determined whether hospitals can
survive a disaster, said a high-ranking HHS official.
Storm-hardened infrastructure is not cheap. Continuum Health,
which operates St Luke’s Hospital in New York where Bondy was
sent, spent about $10 million over the last decade on generators
and other emergency measures. Mount Sinai Medical Center, next
to Manhattan’s Central Park, is replacing four basement
generators with four on higher floors for $12 million.
And many hospitals do not factor in all of the potential
threats. As Sandy barreled toward New York City last weekend,
hospitals tested their generators and assured city officials
that they had enough fuel to run them for several days,
according to all the hospitals interviewed.
NYU’s “emergency power system was designed and built
according to all safety codes,” spokeswoman Allison Clair said.
“We were confident we could withstand a (storm) surge of
approximately 12 feet,” but it was at least a foot higher.
By Monday night, the NYU basement that houses one of its
generators and fuel tanks for the seven on higher floors was
under eight feet of water. Sensors shut down the fuel pumps, and
the generators fell silent.
“There was no electricity and all the IV machines were going
haywire,” said Bondy. “I heard one nurse yell to someone, don’t
use that water, it’s brown. I couldn’t believe how fast things
were failing.”
By all accounts, it could have been much worse had other
preparations not been in place.
The staff used flashlights to carry out the evacuation.
Police officers fanned out through the building and on stair
landings as staff members carried patients to safety, including
critically ill infants. Waiting ambulances – organized days
ahead by the Federal Emergency Management Agency – had come from
hundreds of miles away. Bondy’s driver was from Ohio, and needed
to ask directions to the hospital that was due to receive her.
At St. Luke’s, staffers meeting evacuees had her checked in
and settled in a room within 10 minutes. “Cupcake, don’t worry
about it; we’ve got you,” a nurse told her.
HAND CARRYING FUEL
The response at nearby Bellevue was less coordinated. On
Monday night, the power grid failed in its neighborhood and then
its backup power stumbled as basement pumps meant to deliver
fuel to the main generators on upper floors were flooded.
Staffers hand-carried fuel for hours, but by Tuesday the
situation was desperate. Bellevue began what became a full
evacuation of some 725 patients.
Other city hospitals went into overdrive to receive Bellevue
and NYU evacuees, and no patient deaths were reported. Around
midnight on Monday, Zahava Cohen, nurse manager of the neonatal
intensive care unit at Montefiore Medical Center, was roused by
a knock on her office door.
“They’re calling from NYU,” a colleague told her. “They want
to know how many babies we can take,” Cohen recalled.
Hospitals that remained functional were either lucky or
better prepared. They didn’t lose power. But many were prepared
if they had.
Montefiore built a 5-megawatt co-generation plant for heat
and electricity in 1995, said Ed Pfleging, vice-president of
engineering and facilities, and doubled its capacity a few years
later. The plants now supply 90 percent of the power at its main
campus, allowing the hospital to run for days if the electrical
grid fails.
“During the 2003 blackout, we were the only New York
hospital with fuel power,” he said.
Mount Sinai took in 64 NYU patients and some two dozen from
Bellevue. It did not lose utility power this week, but was
prepared with 13 back-up generators and several separate power
systems if it had. Instead, communications were an Achilles
heel.
Mount Sinai’s chief medical officer, Dr. Erin Dupree, was on
the phone with her NYU counterpart on Monday night to discuss
the evacuation, But they were repeatedly cut off as landlines
and mobile phones failed throughout the city.
“We literally had no communications with these people,” she
said. “They were in the dark, and we didn’t know who was coming
here.”
That also could have been predicted. Loss of communication
contributed to the scope of the Sept. 11, 2001, attacks in New
York, when emergency responders were unable to receive
instructions and information in the minutes before the collapse
of the World Trade Center towers.
“We all lost telecommunications on 9/11,” said Gail Donovan,
chief operating officer of Continuum. “After Sandy we had
limited cellphone capabilities at Beth Israel,” one of
Continuum’s Manhattan hospitals, “so we used walkie-talkies.”
EMERGENCY DRILLS LIGHT ON DETAIL
What hospitals must do to harden themselves against disaster
is determined by a patchwork of federal, state and local
regulations. The Joint Commission mandates a long list of
preparedness steps, including running disaster drills.
But many hospitals just go through the motions, said Dr. Dan
Hanfling, special advisor on emergency preparedness at Inova
Health System : “Until events of Sandy’s magnitude
come along, emergency preparedness is just a box that has to be
checked.”
Virtually no emergency drills simulate a disaster inside a
hospital. “I can’t remember the last time a hospital ran a
disaster drill where the hospital itself was the site of the
disaster,” Kellerman said.
The Commission also requires hospitals to maintain back-up
power equipment and test it 12 times a year for half an hour and
for four hours once every three years. There is no requirement
for war-gaming a situation that knocks out that equipment.
Only with “new construction or renovation projects” are
hospitals supposed to place such equipment above flood level,
explained the Commission’s Mills, and even in those cases it is
something that “should” be considered but is not required. That
means the stricken New York hospitals are not unusual.
“We are definitely making progress in preparedness, but many
hospitals are still trying to figure this out,” said Inova’s
Hanfling. “They would fare about the same” should another storm
like Sandy roar ashore.
