This subject didn’t get a lot of play in some of the national media, but the hospital and nursing home industry along the east coast was faced with a number of challenges as reports of over 7,000 patients had to be evacuated in New York City alone. Here is a quick collage of articles talking about the experience. I also found on the internet a 2006 NYC Hospital Evacuation plan that was created during the HRSA HPP era.
-Dick Bartlett, Emergency Preparedness/Trauma Coordinator, KY Hospital Association –

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NYC Hospital Evacuation Plan (HRSA Grant 2006):
http://www.nyc.gov/html/doh/downloads/pdf/bhpp/bhpp-hospital-nyctpevac-plan.pdf

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NY hospital staff stayed with patients too ill to move during Irene

(CNN) — When New York City Mayor Michael Bloomberg instructed five hospitals to evacuate their patients from Hurricane Irene’s path, one replied it couldn’t follow his order.

Administrators from New York University-Langone Medical Center explained that six patients in the intensive care unit were so sick that moving them might kill them, and so the mayor’s office gave permission to keep them in the hospital throughout the storm.

It then fell to Elaine Rowinski, nurse manager of the intensive care unit, to find seven nurses willing to stay at the hospital, right in the hurricane’s predicted path and just 100 yards from the East River, which many feared would overflow. It turned out she had nothing to worry about.

“I could have had 20 nurses if I’d needed them,” she said. “That’s how many called me up to volunteer.”

Rowinski stayed at the hospital all weekend as the doctors and nurses who also stayed listened to the wind and the rain through the boarded-up windows.

“I had no qualms about staying, no fears at all,” she said. “We train for these disasters.”

Brainstorming with her staff, Rowinski came up with a list of what they might need during the storm. The nurses kept flashlights by each bedside and plugged machines into the red outlets on the wall, which connect to the generators on top of the building, in case they lost power from Con Edison. They also kept a three-day supply of medicine next to each patient’s bed in the event they needed to evacuate quickly.

About 200 staff members stayed at NYU, including engineers, security guards, housekeepers, blood bank staff, and two doctors.

As for Rowinski, she finally went home Monday afternoon after nearly three days straight at the hospital. While she was working, her husband had to evacuate their house in Oceanside, on Long Island.

Source: http://www.cnn.com/2011/HEALTH/08/29/irene.nurses/

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Irene creates paperwork tangle for hospitals

Hospitals transferred patients back and forth as the major storm bore down on New York City, and now administrators face the challenge of figuring out who pays for what.

On Monday, many of the patients who had been evacuated from hospitals and nursing homes in advance of Hurricane Irene were transferred back—leaving financial chaos in the hurricane’s wake.

Sorting out the billing for the evacuations and patient transfers could take days. Patient care, staffing, transportation, ambulances, food—all of it must be reimbursed. Patients were transported in ambulances, ambulettes, buses and, in some cases, by private car. Medical staff visited their patients at their temporary quarters. Costs were incurred by both the evacuated and receiving institutions.

“The question is, who pays for what? Who bills for the services and costs incurred?” said Richard Herrick, CEO of the New York State Health Facilities Association, a long-term care facility trade group.

Evacuation of a nursing home is a rare event, he added, but in this case, roughly 15 homes in the state were evacuated. “The scale of this event was unprecedented,” he said.

Many questions have arisen. What is the Medicare and Medicaid reimbursement policy with respect to the transfer of patients between institutions? If a federal disaster area is declared, do the feds pick up the tab? How will private insurers pay for the costs incurred?

On Tuesday, New York Gov. Andrew Cuomo and New Jersey Gov. Chris Christie requested an expedited major disaster declaration from the federal government to help deal with the storm’s aftermath.

Last Friday, Greater New York Hospital Association raised the issue with its members. The trade group got assurances from the state Department of Health that Medicaid will provide appropriate compensation to both the receiving and transferring facilities. The hospital association also informed members that the health department asked Medicaid managed care plans and commercial insurers to relax utilization controls and network requirements so that patients could receive services if they relocated.

The health department is looking at several possible reimbursement models, and will check with the federal Centers for Medicare & Medicaid Services to make sure they meet federal guidelines. The state health department also will address reimbursement issues on its website.

A Centers for Medicare & Medicaid Services spokesman said that if a hospital needed to transfer a Medicare patient because of an emergency evacuation, the normal transfer payment policies would apply. “The payment would not be dependent on the formal declaration of an emergency,” he said.

Mr. Herrick said that he hoped reimbursement decisions would be made within 10 days so that nursing homes won’t have to wait for payment. But, he cautioned, “my assumption is some costs will never be reimbursed.

“It is a very fragile time financially for nursing homes, and I have to think they showed a tremendous amount of good faith that it will all turn out positive,” he said.

By Monday afternoon, nursing home patients were still being transferred back to their home institutions, said Neil Heyman, president of the Southern New York Association, which represents nursing homes in the New York area.

He estimated that about 5,000 nursing home residents were involved in evacuations in New York City’s Zones A and B. Some nursing homes chose to shelter-in-place because there were not enough beds at other facilities.

“There were a few things that didn’t happen according to script, but overall, the evacuations worked,” he said. He describes the crisis as a “fantastic learning experience. We got everyone to safety in a remarkably short period of time, which shows how wonderfully cooperative people can be.”

Read more: http://www.crainsnewyork.com/article/20110830/FREE/110839992#ixzz1WXprMqoJ

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After the hurricane
East Coast hospitals pick up pieces after Hurricane Irene
August 29, 2011 – After Hurricane Irene barreled up the East Coast this weekend, hospitals are dealing with the storm’s impact and attempting to resume normal business operations.

Hospitals from North Carolina to New York this weekend braced for the hurricane’s effects by evacuating patients and instituting mandatory lockdowns. Overall, Hurricane Irene dumped more than one foot of water over North Carolina and spawned tornadoes in Delaware, Maryland, and Virginia. The storm caused power outages for more than three million homes and killed 21 people, CNN reports.

According to Modern Healthcare, the storm knocked out power at Morehead City, N.C.-based Carteret General Hospital, which said on its Facebook page that it was running on generators. Meanwhile, the Middletown Times Herald-Record reports that hospitals in New York’s mid-Hudson Valley are battling with the impact of flood waters.

For example, roads leading to Wallkill-based Orange Regional Medical Center were cut off by flood waters. In addition, bridges surrounding Warwick-based St. Anthony Community Hospital were washed out, stranding the facility on an island, a spokesperson said. However, the hospital continued to function and was fully staffed.

Hospitals accommodating evacuated patients
Facilities throughout New Jersey and New York have been making room for patients who were evacuated from other hospitals in the region. For instance, Maimonides Medical Center in Brooklyn accommodated more than 100 patients from NYU Langone Medical Center and Coney Island Hospital.

According to Long Island Newsday, several New York hospitals reopened their doors on Sunday after evacuating patients. Both campuses of Staten Island University Hospital on Sunday received permission from the State Health Department to reopen. Patients on Sunday were transported back to the hospitals or released, and hospital employees were expected to report to their usual posts on Monday.

NYT highlights challenges of hospital evacuation
The New York Times on Sunday examined hospitals’ evacuation processes ahead of the storm, noting that many facilities had trouble accommodating an influx of patients. According to the Times, while some evacuations were planned, many patients arrived at hospitals unannounced, causing some patients to wait in line to enter the ED.

In addition, the Times notes that although hospital staff from other facilities traveled with patients to monitor their care, they often had trouble assimilating to a new hospital’s procedures, which caused treatment and test delays.

However, the chair of the department of emergency medicine at SUNY Downstate Medical Center said he was pleased with his disaster command team’s response, noting that staff had the opportunity to practice skills needed to respond to a more severe disaster (CNN, 8/29; Barr, AP/Modern Healthcare, 8/27 [subscription required]; Barr, AP/Modern Healthcare, 8/28 [subscription required]; Fiore, MedPage Today, 8/27; Paulsen, Staten Island Advance, 8/28; Ochs, Newsday, 8/28; Fink, Times, 8/28).

Source: http://www.advisory.com/Daily-Briefing/2011/08/29/Aftermath-East-Coast-hospitals-pick-up-pieces-after-Hurricane-Irene

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Health Risks For The Elderly And Sick In A Natural Disaster
(The Huffington Post) – For many up and down the East Coast who braced for Hurricane Irene this past weekend, the experience was a serious wake-up call for how prepared we are (or aren’t) for a natural disaster. Flashlights flew off shelves, bread disappeared from the supermarket, bottled water became a scarce resource and batteries were nowhere to be found.

But for the elderly and chronically ill, the realities of widespread damage, hospital evacuations, pharmacy closures and power outages took on a whole new meaning.

During Hurricane Irene, in New York City alone about 7,000 sick and elderly patients in hospitals and nursing homes were transported to a safer location to ride out the storm — the move was followed by an unprecedented evacuation for all of the area’s residents, as well. And while the densely populated city received the brunt of the media coverage, it was hardly the only area to evacuate patients — one Maryland hospital evacuated and closed, for instance, after serious damage was sustained to its building structure.

Yet while evacuations can save lives, there can also be instances of patients who are too critically ill to risk the consequences of moving hospitals. At New York University-Langone Medical Center, for instance, providers feared that transporting six of the patients could result in death — prompting a small group of nurses to collect flashlights to keep bedside, along with a several-day supply of medicine in case evacuation became completely necessary, CNN reported.

How To Plan Ahead

Government officials encourage residents to pack up an emergency bag, including a week’s supply of any medications, medical items or supplies — and this type of kit should always be ready for an unexpected disaster, not just a forecasted hurricane.

The CDC also has compiled a list of specific to-dos and support for people with various chronic conditions, including cancer, diabetes and high blood pressure, among others (check out their full guides here). Various weather conditions, for instance, can affect the potency of insulin or the accuracy of blood glucose monitors for diabetics, while people with certain disabilities will need a detailed plan for how to get assistance and possibly additional items to throw into their emergency kits. According to the FDA, certain medications need to be discarded if they come in contact with flood water or contaminated water — check out their complete guidelines (and other health safety tips) here.

Some may also find it helpful to have all prescriptions and doses written down and accessible ahead of time to have on hand if disaster does strike — Rx Response, an organization designed to maintain public health during emergencies, allows you to customize a wallet card with personal information, blood type, doctor contacts, emergency contacts, medications, allergies and current conditions.

Make Use Of Post-Emergency Resources

Inevitably, there will be some times when you cannot be completely prepared. If you’re short on a prescription, Rx Response compiles maps of open pharmacies during major natural disasters and other emergencies (check out their maps for Irene to find out what’s open in your area here).

“First, it lets the public know where they can find an open pharmacy in areas hard hit by the storm so that they can get the medicines they need,” Erin Mullen, RPh, PhD, CEM., Director of the Rx Response program, said in a statement “Additionally, it helps emergency managers to better meet medical needs in storm-affected areas.”

If you’re in serious, life-threatening danger, always call 911. For more information, visit the NIH’s guide to emergency and disaster preparedness for various special populations.
Source: http://www.huffingtonpost.com/2011/08/30/hurricane-elderly-sick_n_941115.html?view=print&comm_ref=false

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The KHA Emergency Preparedness Update is assembled by Dick Bartlett (dbartlett@kyha.com) several times a week, and when events make it necessary it may be sent out several times a day to keep our hospital and healthcare community advised on preparedness news and information. Most of this information is compiled from open sources, and where possible reference links will be provided. If you would like to added or deleted, please contact preparedness@kyha.com. The preparedness program for KHA and KHREF and supported by US DHHS ASPR HPP funds through a contract with Kentucky Public Health.

The information contained in this message (including all attachments) may be privileged and confidential and protected from disclosure. If the reader of this message is not the intended recipient, or an employee or agent responsible for delivering this message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this information is strictly prohibited. If you have received this communication in error, please notify us immediately and delete or destroy the material and information.

Linda Todd
Life Sciences Librarian
Catholic University of America

I attended the talk given to DCAHSL in Washington DC on 3/28/11, as well as the NLM symposium on Disaster R & P on 3/29 and 3/30. I asked about the one-shelf disaster library, and have found the image on the NN/LM toolkit page, but not the titles. Do you have a list of the titles?
Thank you.

Linda Todd
Life Sciences Librarian
Catholic University of America

Comment by Cindy Love, Disaster Information Management Research Center, NLM