“After Hurricane Sandy: Lessons Learned for Bolstering the Resilience of Health Systems and Services”
Total Page:16
File Type:pdf, Size:1020Kb
“After Hurricane Sandy: Lessons Learned for Bolstering the Resilience of Health Systems and Services” Hosted by Kostas Research Institute for Homeland Security, Northeastern University & Columbia University’s National Center for Disaster Preparedness Read Ahead Materials Table of Contents Summaries of Reports .......................................................................................................................................3 “Hurricane Sandy: Lessons Learned, Again” (David M. Abramson and Irwin Redlener, December 2012) ............................................... 11 “Lack of Authority” (Sasha Chavkin, February 1, 2013) ....................................................................................... 13 “The Long Road to Recovery: The Environmental Health Impacts of Hurricane Sandy” (John Manuel, May 2013) ....................................................................................................... 16 “A Hospital System’s Response To A Hurricane Offers Lessons, Including The Need For Mandatory Interfacility Drills” (Christina Verni, August 2012) .............................................................................................. 24 “Facing Uncertainty — Dispatch from Beth Israel Medical Center, Manhattan (Sushrut Jangi, December 13, 2012) ..................................................................................... 32 “Disaster Resilience and People with Functional Needs” (Sophia Jan and Nicole Lurie, December 13, 2012) ............................................................. 35 “Identifying Disaster Medical and Public Health Research Priorities: Data needs arising in response to Hurricane Sandy” (New York Academy of Medicine, November 16, 2012.) .................................................... 37 “Hurricane Sandy After Action Report and Recommendations to Mayor Michael R. Bloomberg” (Deputy Mayors Linda I. Gibbs and Caswell F. Holloway, May 2013) .................................... 60 “Emergency Preparedness and Public Health The Lessons of Hurricane Sandy” (Tia Powell, Dan Hanfling and Lawrence O. Gostin, November 16, 2012) ....................... 65 “Lessons from Sandy – Preparing Health Systems for Future Disasters” (Irwin Redlener and Michael J. Reilly, December 13, 2012) ....................................................... 69 “Shelter From the Storms” (Sheri Fink, October 27, 2013) ................................................................................................................... 72 “A Stronger More Resilient New York: New York City Healthcare Findings” (NYC Special Initiative for Rebuilding and Resiliency, July 2013) ........................................... 75 “A Survey of Hospitals to Determine the Prevalence and Characteristics of Healthcare Coalitions for Emergency Preparedness and Response” (Kunal J. Rambhia, Richard E. Waldhorn, Frederick Selck, Ambereen Kurwa Mehta, Crystal Franco, and Eric S. Toner, June 4, 2012) .............................................................................. 90 “The Next Challenge in Healthcare Preparedness: Catastrophic Health Events” (Center for Biosecurity of UPMC, January 2010) ........................................................................... 100 “After Superstorm Sandy: Lessons Learned for Bolstering the Resilience of Health Systems and Services” Hosted by The Center for Resilience Studies of Northeastern University & The National Center for Disaster Preparedness at the Earth Institute, Columbia University Lerner Hall (2920 Broadway) Room 555 Columbia University December 3, 2013 Executive Summaries of Read-Ahead Articles “Hurricane Sandy: Lessons Learned, Again.” David M. Abramson and Irwin Redlener, Disaster Medicine and Public Health Preparedness, 2012. In the wake of Hurricane Sandy, gaps in planning were quickly revealed when it came to providing relief. This was not so much an issue of capacity or capability, as it was of communication and coordination. “Medical humanitarianism” efforts were launched where doctors volunteered to work in mobile medical units and hospital nurses and clinicians volunteered to staff functional needs shelters. But these often heroic efforts could have benefited from better advanced planning. Too often, “resources did not always make it the last mile to reach those in need.” Climate scientists and public agencies have long predicted the potential devastation a storm could bring to the region, warning of “structural damage and impaired operations of communications, energy, transportation, and water and waste infrastructure; reduction of water quality through saltwater intrusion into aquifers; and inundation of low-lying areas and wetlands.” In the end, the “…disciplines of medicine and public health can learn lessons, again, from Sandy: to develop more integrated systems, to practice and train together, and to build redundancy into everything.” “Lack of Authority.” Sasha Chavkin, The New York World, February 1, 2013. Following Hurricane Sandy, there were major challenges associated with delivering disaster relief services to the elderly and disabled in New York City public housing. There is a need for policy reform particularly with regard to clarifying the responsibilities of the New York City Housing Authority (NYCHA), and the City of New York for providing assistance to public housing residents. Primarily non- profit groups delivered health services in the wake of Hurricane Sandy because there were no measures put in place by the NYCHA or other city agencies to reach vulnerable residents who had not been evacuated and who ended up stranded in their homes due to power loss or pre-existing medical conditions. Demographic trends and fiscal challenges are adding to the difficulties for delivering medical assistance to residents in public housing. The NYCHA must contend with large budget deficits that can hinder the ability of the Authority to deliver services, even when the internal NYCHA registry of individuals with functional needs is accurate. 1 “The Long Road to Recovery: The Environmental Health Impacts of Hurricane Sandy.” John Manuel, Environmental Health Perspectives, May 2013. Hurricane Sandy generated a variety of environmental health threats. Immediate health threats arose from storm surge and fire, with drowning constituting the most common cause of death in the New York metropolitan area. Power loss compromised critical systems such as heating, elevators, life support, and other technologies that presented significant challenges especially for people living in high-rise apartments, especially the elderly or those with medical conditions. Long-term threats include degradation of air and water quality, and mold growth. The loss of power to wastewater treatment plants can significantly pollute the water supply. Sediment deposited by floodwaters combined with debris from damaged and destroyed buildings can degrade air quality. Improper or incomplete restoration of waterlogged houses could lead to significant mold growth, especially in inaccessible wood-to-wood interfaces. Many environmental health impacts are inter-related, and the combination of several threats can pose significant risks to public health in the wake of a disaster. “A Hospital System’s Response to a Hurricane Offers Lessons, Including the Need for Mandatory Interfacility Drills.” Christina Verni, Health Affairs, August 2012. This case study explores the lessons learned when the North Shore–Long Island Jewish Health System, a large, integrated health network in New York, evacuated three hospitals at high risk of flooding from Hurricane Irene in August 2011. The episode resulted in the evacuation, transport, and placement of 947 patients without any resulting deaths or serious injuries. This case demonstrates the utility of having in place a functional evacuation plan, such as the one North Shore–Long Island Jewish Health System developed through its own full-scale exercises in the years following Hurricane Katrina in 2005. In those drills, the health system discovered that it needed to abandon its 1:1 matching of patients to available beds in the region in favor of the group transport of patients with similar needs to facilities that could accommodate them. Despite its overall success, the system identified the need for internal improvements, including automated patient tracking through the use of bar-coded wristbands and identification and training of additional backup personnel for its emergency operations center. Among other changes, policy makers at the state and federal levels should consider mandating full-scale interfacility evacuation drills to refine mechanisms to send and receive patients. “Facing Uncertainty - Dispatch from Beth Israel Medical Center, Manhattan.” Sushrut Jangi, M.D., The New England Journal of Medicine, December 13, 2012. Beth Israel Medical Center lost power from the electrical grid at approximately 9pm October 29, 2012 and activated it emergency back-up generators. NYU Langone and Bellevue hospital lost power and had to evacuate making Beth Israel the only operating hospital in Lower Manhattan. With the intercom and 2 paging system down, hospital staff used the available Wifi and their smartphones to download an app that allowed them to create an impromptu paging system to respond to codes. During the storm and its aftermath, patients arriving in the Emergency Department doubled in volume. This was primarily as a result of patients who needed crucial prescription refills or essential health services that depended on electric power. This