Healthcare Matters

There is no such thing as an evacuation decision-making algorithm. How could anyone reasonably expect to identify all the potential disaster scenarios or capture all the possible nuances involved in a decision to evacuate a hospital? Comprehensive plans and checklists that help hospitals develop and execute evacuation and re-sheltering exercises –yes. In fact, providers are now required to have these in place. And thankfully, regularly scheduled, inter-facility training exercises are becoming the norm for providers located in coastal areas and other parts of the country where earth quakes, wild fires and flooding are naturally occurring.

We’re good at compiling our “lessons learned” after each disaster. And if you listen to what those who have lived through one have to say, there are, fortunately, some common themes. Interestingly, shortly after the Joplin tornado disaster (a devastating incident with virtually no warning) the Missouri Hospital Association (MHA) put together one of the best disaster planning guidelines I’ve seen:

• Communications. Strategic and tactical communication is critical to coordinating employees, the media, and the public, and must include redundant types of equipment that workers are trained to use.
• Practice and Evaluation. Hospitals must test all emergency plans to identify and correct weaknesses.
• Medical surge. Emergency plans must establish detailed procedures for patient care in conventional, contingency, and crisis settings and include solutions to limitations of staff, supply, and space.
• Planning. Creating emergency plans provide staff with critical thinking skills needed to manage disaster responses. As such, all employees should be involved in and understand the plan and hospitals should plan and practice with their regional and state partners.
• Resources and assets. Hospitals should task an individual with supply management during a disaster to evaluate supply levels, monitory supply use, and anticipate needs.
• Safety and security: Hospitals should be aware of imposters and opportunists who try to take advantage of crisis situations.
• Staffing. Hospitals should decide how to manage and care for hospital staff during disaster response and recovery. We tend to overlook that hospital staff and their families can also be victims of the same disasters that impact patients.
• Volunteers.  Hospitals’ plans should incorporate ways to accept, credential, and use volunteers who do not have basic lodging and food accommodations.
• Utilities. Hospitals should not depend on utilities and should consider redundant systems and partnership for water and power sources.

Over 200 patients at New York University Langone Medical Center-Tisch Hospital were being evacuated last night after power went out as a result of Superstorm Sandy. Primary generators began to go down. Backup generators were in operation, but they, too, started to fail in the 11 p.m. hour. The decision to evacuate was made and the exercise began.

An army of 50 to 70 ambulances lined up along 30th Street at First Avenue where the hospital is located. They lined up all the way to First Avenue, around the corner to 30th Street and police officers successfully re-directed traffic. Because there are no elevators in the building, patients were carried down stairs on special stretchers. 20 babies in the neonatal unit, four of which were on ventilators, were quickly removed from the hospital. Patients were taken to Mt. Sinai, Memorial Sloan-Kettering and the Hospital for Joint Diseases, as these “disaster partners” had been matched up based on the similarity of their service lines.

Of course, the specific details are not yet available, but it sounds like NYU Langone Medical Center-Tisch Hospital had its act together.

—Tom Finn