By Sheri Fink
Hurricanes Katrina,Sandy tested US reflexes. What can we learn from the medical response?
WHEN the floodwaters rose around New Orleans hospitals after Hurricane Katrina in 2005,doctors wondered whom to rescue first. Sick babies? Critically ill adults? The elderly? More than seven years later,as Hurricane Sandy hit New York City,Bellevue Hospitals basement filled with millions of gallons of floodwater from the East River. The physician heading the intensive care unit was told that most backup power was likely to fail. She would have six power outlets. Which of her 50 patients should get one?
Doctors faced these impossible choices because our creaking medical infrastructure leaves American hospitals,nursing homes and high-rises for the elderly vulnerable to even the most foreseeable disasters. Plans to get patients out of harms way are also inadequate.
Since Sandy hit a year ago,hard-working health and hospital officials have made good progress in defining the risks,but less headway in actually implementing solutions. We need to do more. Over a third of the beds in New York Citys hospitals and nursing homes and more than half of those in adult care facilities are in hurricane evacuation zones. Vital mechanical elements remain unprotected in basements or on lower floors. Sandy displaced more than 6,400 patients. Some were evacuated in the midst of the storm,without medications or records,and family members could not find them. The disaster forced the closing of six city hospitals and 26 residential care facilities. It resulted in an estimated billion dollars in hospital emergency response costs and another billion dollars in repairs.
Outpatients,too,suffered. Doctors offices,pharmacies and dialysis and methadone clinics were inundated or lost electricity. Thousands of disabled and elderly residents were trapped for weeks in high-rises without power,elevator service or heat. A class-action lawsuit has been brought against the city on behalf of hundreds of thousands of disabled New Yorkers for alleged defects in planning. This May,the department of justice filed a statement in support of the disabled residents,noting that emergency plans throughout the nation failed to account for their unique needs.
So now what? We need both immediate and long-term solutions. On a federal level,the Centres for Medicare and Medicaid Services should release long-delayed emergency preparedness requirements. CMS should also adopt updated life safety code standards from 2012 that require new health care facilities to protect electrical components. Amazingly,the government is still relying on weaker standards from 2000.
States and localities can also impose more stringent building codes. New York City and New York State have proposed that any newly constructed hospitals or those undergoing significant renovations be floodproofed to a 500-year flood standard and that air-conditioning be able to run on emergency power. This needs to be replicated elsewhere. Rural areas,which have fewer hospitals,making them less replaceable,need help,too.
As ambitious as they are,New York Citys building plans exempt existing hospitals from compliance with even the most important new standards until 2030. That deadline was set in light of fiscal realities,according to one city official. But priorities create realities,and deadlines slip. Hospital owners need to do the right thing.
We can learn from mistakes the mayors of both New York City and New Orleans allowed hospitals and nursing homes to keep patients in place for serious storms. Before the current hurricane season,New York State health officials surveyed facilities ability to shelter in place and accept other patients,but they havent analysed the data yet or used it to redraw plans. The state health department recently implemented a barcoded wristband system to track patients in an emergency. Similar solutions have been used elsewhere and should be considered nationwide.
New York City officials have also proposed a database of vulnerable residents and their emergency needs. Obstacles include finding funding and navigating federal privacy rules that make it difficult to share vital information. These laws should be amended to prioritise saving lives.
Flexibility is crucial,but making adjustments to a well-practised plan is easier than rank improvisation. Federal Hospital Preparedness Programme funding dropped from nearly a half-billion dollars a year a decade ago to $332 million today. Failing to invest more is a choice: when disaster strikes,we will allow the weakest members of our society to suffer and die disproportionately. Why are we taking that chance?
The writer is the author of Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital The New York Times