Medical Residency Training and Hospital Care During and After a Natural Disaster: Hurricane Sandy and Its Effects
During natural disasters, resident physicians in teaching hospitals play an integral role in ensuring continuous patient care. The challenges that a residency program experiences as a referral hospital after such calamities have not been documented in the past. However, there is literature addressing the demands faced by hospital programs that were forced to close down temporarily, such as what happened during Hurricane Katrina in New Orleans in 2005.1, 2, 3 In this article, we highlight some of what occurred during and after Hurricane Sandy in New York City.
On October 29, 2012, the wind started to blow in New York City. Hurricane Sandy was expected. The implications of this disturbing storm were uncertain. It had been 1 year since Hurricane Irene passed by New York City. Metropolitan Hospital Center (MHC), a public hospital located in East Harlem, in Manhattan, suffered minimal disruptions at that time.
A state of emergency was declared days before Hurricane Sandy, which included the suspension of all public transportation, mandatory evacuation of Zone A (where the MHC staff housing building was located), and closing of all major bridges and tunnels. Likewise, the Department of Medicine at MHC started planning for this natural disaster. A plan for a medical resident backup system was developed. Medical interns and residents who lived near the hospital were identified and informed ahead of time that they would serve as first-line responders as the need arose during this time of anticipated calamity. All residents living outside Manhattan and those evacuated from the hospital’s housing building were encouraged to stay within the city with peers or friends. The program leadership advocated for the solidarity of the house-staff and faculty.
During the day of the storm, volunteer residents were asked to stay in the hospital. At 5:00 pm, we put in place a ward team composed of 1 senior resident, 3 junior residents, and 3 interns, and a medical intensive care unit team of 2 senior residents and 2 interns. Also in-house were 1 of the chief medical residents, 4 medical attending physicians, and the chief of medicine. Everyone volunteered to stay and to work overnight without hesitation despite the fact that they also had families left behind. At 7:00 pm when the winds were very strong, we advised the on-call teams to remain inside the hospital. The night float team was notified not to report for their regular 9:00 pm shift out of concern for their safety. At 9:00 pm, we learned that New York University Hospital was being evacuated and that possibly our institution would accept patient transfers from them.4 At 9:30 pm, First Avenue was flooded and the winds were fierce. Lights on the street gradually faded within the buildings, and the cars were under water. Our institution’s command center provided information by the minute. At 9:45 pm, the lights of MHC went off for the first time. After half a minute, the main emergency generator started to work and the lights came back. The flooding continued and 45 minutes later, the main generator failed, leaving the hospital in darkness. Critical supportive equipment was working with the backup system. The backup generator started to work 15 minutes later; however, large portions of the hospital, including the medical floors and medical intensive care unit, had no electrical power. The transfer of critical patients was coordinated from the medical intensive care unit on the 9th floor to the recovery room (the only unit with full power at that time) on the 10th floor. One by one the patients were transferred by one of our interns and a senior resident accompanied by the nursing staff and an intensivist, by the use of the one and only functioning elevator. On the medical floors, everything was dark. Calls to assess patients became a challenge. At midnight, we received news that we would continue admitting patients. That night, with no electrical power, attention to the patients continued nonstop. The clinical skills of the medical staff were challenged continuously by the absence of full laboratory support and by the lack of electronic medical records until early morning when we got our main generator back.
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– Christian Espana-Schmidt, MD, Erwyn C. Ong, MD, William Frishman, MD, Nora V. Bergasa, MD, FACP, Shobhana Chaudhari, MD, FACP, AGSF
This article originally appeared in the November 2013 issue of The American Journal of Medicine.
