Preparing for the Next Superstorm: Protecting Patients during Natural Disasters 

A Conversation with William L. Carroll, MD

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We are doing a lot on our campus to prevent this situation from ever happening again, so with each new building we construct, we are thinking about where we are putting the energy grid.

—William L. Carroll, MD

When Hurricane Sandy slammed into the East Coast last October, the magnitude of devastation it left in its wake exceeded even the most dire predictions. Eighty mile per hour winds and record storm surges destroyed antiquated electrical grids and flooded subway stations, leaving much of New York paralyzed and in the dark. The storm also caused NYU Langone Medical Center to shutter its doors and evacuate more than 300 critically ill patients, including two dozen patients with cancer, to area hospitals. Hundreds of other patients were discharged the weekend before the storm landed.

The ASCO Post talked with William L. Carroll, MD, Director of the NYU Cancer Institute, and the Julie and Edward J. Minskoff Professor of Pediatrics and Professor of Pathology at NYU Langone Medical Center, about the damage to the hospital and its research laboratories, how the Medical Center is rebuilding to reduce the risk of such catastrophes in the future, and how to ensure that patients receive uninterrupted care when natural disasters strike.

Losing Power

What caused the loss of your backup power generators, necessitating the evacuation of patients to local hospitals? 

We continue to assess the situation, but seven of our eight generators, which were situated above ground, were still functioning during the hurricane, so the generators did not fail. According to New York City building code, the fuel pumps supplying the generators have to be located in the basement, so the biggest culprit in terms of the failure of the generators to supply power to the hospital was actually the fuel pumps, which were submerged in water. 

We were in the midst of a campus transformation project with the construction of a new energy building when Sandy hit us. That new energy building will have a self-generating energy unit so we will not be dependent on New York’s utility company, Con Edison, for power. The self-generating unit will be above ground, but Sandy hit before the building could be completed, which will be by 2015. But the campus was already moving in the direction of having an independent energy source before the storm landed.

Continuity of Care

Where did the patients you evacuated go for treatment? 

When disasters like this strike you recognize the importance of having great colleagues. The bulk of our patients with cancer were cared for at Lenox Hill Hospital, where a designated floor was set up for our staff and patients, and Memorial Sloan-Kettering Cancer Center. The day after the hurricane hit, Dr. Craig Thompson [President and Chief Executive Office of Memorial Sloan-Kettering] called me, and we arranged for our patients to be cared for by Memorial’s oncologists in concert with our oncologists. Our pediatric patients with cancer were taken to Mount Sinai Medical Center, and other area hospitals cared for the rest of the patients. 

All our patients had continued care by NYU doctors. Even though we didn’t have hospital privileges in all circumstances, our patients could still see us on a daily basis, and I think that was critical to their care. So if patients have to be transferred to other venues, my advice is to make sure that their physicians visit them, even if it’s for a social call, because the doctor/patient relationship is crucial. And it works both ways: It was equally important to our doctors to stay in contact with their patients.

 Were you able to transfer patients’ electronic health records to the other institutions? 

No, we couldn’t transfer electronic records, but we did transfer summaries of each patient’s record and it worked out fine. Furthermore, the outside physicians caring for our patients had the cell phone numbers for each patient’s primary NYU oncologist to ensure seamless communication and continuity of care.

Further Precautions

Are there additional steps hospitals can take to ensure that treatment remains uninterrupted during natural disasters like Hurricane Sandy?

We had an evacuation plan in place at the time Sandy struck, and we put together a relationship with area hospitals very quickly to allow patient care to continue uninterrupted. Communication was greatly hampered throughout much of New York. Internet and phone services were down, and that was a real problem for us, because it was really hard to get information to our patients. 

We set up an 800 number with an independent network to be able to maintain continued communication with our patients for the 5 days before electrical power was restored throughout the city. So you need to have that emergency number ready to be operational. I already had phone numbers for all senior staff programmed into my cell phone, and texting worked when regular service was unavailable.

Although many of our inpatients needed to be temporarily treated elsewhere, our outpatient cancer center was able to reopen the Monday following the storm. When we knew that the outpatient cancer center was going to be closed, we were able to make contact with patients through an automated call system. Once we knew power was restored to the Midtown area, we made a concerted effort to make personal calls to reschedule patients who missed their appointments. Hours of operation were extended as well to accommodate the additional volume. From a telecommunications perspective, the ability to contact our patients was sometimes challenging.

I’m a pediatric oncologist, and the second day after the storm, the mother of one of my young patients walked all the way from Chinatown to the medical center—about 3 miles—with her 2½-year-old child, and I just happened to meet her there. It was very emotional to meet up with my patient in those circumstances and to know that things were still all right, reinforcing how critical communication is during a disaster like this. 

Getting the Word Out

How were you able to announce the 800 number to your patients?

In addition to working with local and national media to inform our patients of the status of the medical center, we also used other venues such as social media for patients who were able to access the Internet. We posted information on NYU’s Facebook page and kept patients informed that way, so I would also highly recommend using social media to get the word out. Our medical center website home page was updated on a regular basis as well.

Calculating the Losses

How severe was the flood damage to your basement research laboratories?

Estimates of the destruction are between $50 million and $100 million, but we are still evaluating the loss. Importantly, we did not lose clinical samples housed in our biobank. We place a high priority on clinical samples because that is a legacy for future generations, and those were protected in tanks of liquid nitrogen and/or housed in separate areas in anticipation of something like this happening. 

Of course, reagents and peoples’ time (when it comes to conducting experiments) were lost, and we are still determining how to calculate those losses.

Research Setbacks

How much time was lost in advancing the center’s research?

I think the majority of researchers had their work set back between 3 and 5 months. For those who lost laboratory animals, there was a more severe setback. One research building still had emergency power, and we were able to transfer reagents to that building. A lot of this work was done by hand through the heroics of post-docs and graduate students who carried samples to the building. But we did lose reagents, and the severity varies among investigators.

We were able to reopen our inpatient hospital on January 14, and many of the research labs came back well before then. So while the storm caused a major blow, we are now up and fully operational, and our research is continuing. 

Closing Thoughts

What advice do you have for ASCO members on how to protect their patients with cancer in similar circumstances?

An evacuation plan and a plan for providing alternatives for continued care are important. We are doing a lot on our campus to prevent this situation from ever happening again, so with each new building we construct, we are thinking about where we are putting the energy grid, which is why our new energy building is so important. 

I think every hospital has to consider a similar solution. Should power go down, even with emergency generators, how long will that power last? Having an independent, self-generating source of energy is key. Having a plan in place to be able to maintain communication with patients is also crucial. ■

Disclosure: Dr. Carroll reported no potential conflicts of interest.

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