Nearly five years ago, on October 29, 2012, New York City encountered one of the most massive super storms that the Northeast has ever faced, Hurricane Sandy. The storm wreaked havoc throughout the entire state, with the inclement weather causing widespread power outages, extensive flooding, and the displacement of a record number of families. Although government preparations were made far ahead of the storm and communities believed themselves to be adequately organized, the brute force of the hurricane delineated the lack of preparedness throughout several levels of society.
Even more worrisome was the fact the care available at hospitals in the New York City area also failed. This was evident through several hospital failures, emergency evacuations, poor communication, and months of extremely overcrowded emergency rooms. These shortcomings demonstrate that healthcare facilities and emergency rooms cannot solely rely on government preparations, but instead need a well-rounded societal approach to confront community based needs, especially in times of large-scale and catastrophic events.
As Hurricane Sandy made landfall as a Category One storm right in the bight between the coastlines of New York and New Jersey, the storm surge was guided directly into New York City. As a result, New York City hospitals and their partners were forced to evacuate approximately 6,300 patients from thirty-seven health care facilities across the five boroughs.[1]Even though New York City emergency partners and coalitions had efforts in place, the unexpected severity of Hurricane Sandy caught New York City hospitals by surprise, because major hospital evacuations are usually one of the last resorts.
Unfortunately, the hospital closure created a snowball effect that began with numerous power outages, forcing hospitals to rely on backup generators, which subsequently failed because of flooding. Due to this, as health care facilities were evacuated, neighboring institutions were burdened with receiving the displaced patients. For instance, NYU Langone Medical Center had to evacuate a major portion of their center without elevator power. The emergency evacuations of NYU Langone and Bellevue were complex and chaotic, as approximately 1,000 patients were transported to receiving hospitals, mainly in Manhattan, over a span of three days. There was a large shortage of ambulances and ambulettes, which almost involved the critical implementation of Taxi and Limousine Commission in order to transport non-life threatening patients. Even with this substantial assistance, seven participants in the joint commission survey “noted several challenges with the EMS response, including personnel who were unfamiliar with the city’s geography and the location of some receiving facilities, environmental conditions, lack of centralized command and control for EMS operations at the two sending facilities, provider fatigue, and lack of fuel.”[2]
The multitude of capability and effectiveness shortfalls throughout New York City demonstrated that policymakers and the public simply did not have the information needed to assess the legitimate performance of the preparedness level. The usual approach of reviewing policies for preparedness is termed the “rearview mirror” method, since cities learn from observed failures. However, “while learning from real-world experience is important, decision makers need better ways to assess preparedness prospectively to make better choices as to how and where to strengthen it. The country also needs better ways to assess preparedness levels so citizens can set reasonable expectations about the performance of national, state, and local response systems and can make judgments about how confident they should be that the system will be able to deliver when they need it.”[3] This whole-community approach would be greatly beneficial on local, state, and federal levels, as communication, comprehensive partnerships, and critical response would be enhanced.
Overall, New York City is one of the most resourceful cities in the United States when it comes to emergency preparedness. The potential coalition of research and an abundance of government agencies provide New York with capabilities that other areas simply do not possess. However, even with all these advantages, disasters and calamities have still proved the guidance of only the government is not enough. Communities place too great a responsibility on local, state, and federal agencies to address all the negative consequences of a disaster. Hence, this path dependency has framed the issue as a poor job in preparedness by the city and or state. Looking toward the future, with additional research and data, the government should continue to make crucial improvements and incorporate the whole community approach method. The results in turn will be much more beneficial, as through the expansion of hospital networks, restructuring of the 911 system, increase in volunteers, utilization of social media, and extensive individual preparedness, a well-rounded societal approach would be created. New York City would enhance their preparedness level and be able to confront community based needs, while no longer burdening healthcare facilities.
[1] Gibbs, Linda, and Caswell Holloway. “Hurricane Sandy after action: report and recommendations to Mayor Michael R. Bloomberg.” Hurricane Sandy After Action: Report and Recommendations to Mayor Michael R. Bloomberg, The City of New York, New York, NY 36 (2013).
[2] Adalja, Amesh A., Matthew Watson, Nidhi Bouri, Kathleen Minton, Ryan C. Morhard, and Eric S. Toner. “Absorbing citywide patient surge during Hurricane Sandy: a case study in accommodating multiple hospital evacuations.” Annals of emergency medicine 64, no. 1 (2014): 66-73.
[3] Jackson, Brian A. The Problem of Measuring Emergency Preparedness. Rand Corporation, 2008.
