Five years ago Hurricane Sandy battered and inundated the Northeast, forcing the evacuation and shutdown of New York University’s Langone Medical Center in New York City.

“The hospital employees knew that they would be unlikely to come back on time with the hurricane coming up the coast, and made plans for their children to be taken care of and made certain that there were sufficient supplies in the house,” says Victoria Raveis, PhD, a research professor at NYU who recently published an analysis of the hospital’s response to Hurricane Sandy. “What they didn’t anticipate — which we really didn’t expect — was the whole shutdown of communications and a complete lack of power. There was failure of cellphones not being able to be charged, and communication at the critical points in time was not there. That caused a lot of stress.”

Raveis and colleagues recently published an analysis of how NYU nurses were affected by the event, suggesting planning strategies for hospitals affected by major storms and disasters. The researchers interviewed 16 nurses who participated in the medical center evacuation, and bolstered those narrative accounts with survey results from 528 registered nurses working at the hospital at the time.

“Accounts described dealing in the immediate recovery period with unexpected job changes and resultant work uncertainty,” the authors noted. “The storm’s lingering aftermath did not signify restoration of their pre-disaster lifestyle for some, but necessitated coping with this massive storm’s long-lasting impact on their personal lives and communal loss.”1

Indeed, the storm spilled over from work into nurses’ personal lives, as 25% reported property damage or loss and 22% actually had to relocate after the hurricane. Psychological problems were reported by some of the nurses, with 4% citing “disturbing thoughts” and 4% difficulty sleeping. Support from co-workers, hospital leadership, and loved ones was an important buffer against this angst.

“The family members were really concerned about the hospital employees who, in this case, were kind of cut off from the world,” Raveis says. “That is a level beyond just the functions of the hospital. I think what we learned from Hurricane Sandy with the hospital closure is that personal lives are really an important aspect. The non-professional aspect of [the worker’s] life also needs to be connected to the disaster planning.”

Hospital Employee Health asked Raveis to share more details of the disaster in the following interview.

HEH: What happened during Hurricane Sandy to knock out power at Langone Medical Center?

Raveis: The flood waters rose into the sub-basement, which was built with walls to prevent lower waters from coming in, but once those walls were breached there was no way for it to go out. That flooded the source of power, and also the fuel for the generators was kept down in the basement. The patients had to be evacuated because there was absolutely no electricity for anything in the building. They had previously moved patients to areas of the hospital anticipating the hurricane blowing in windows. Those types of plans were in place, but they never anticipated that they would have to completely shut down the hospital due to a complete power failure. There were procedures in place to use “med sleds” to physically slide and carry patients down the staircases, but it was a plan that they had not anticipated they would have to use at that point. They thought that they would be fine, but when it came down to the hospital being able to safely operate and provide the care the patients needed, they had to evacuate. They were using manual ventilators for patients that needed oxygen.

HEH: What kind of training and preparations do you recommend?

Raveis: For people who have a first responder role, do some pre-disaster planning. This is a recognition that they have personal lives. One example is that people in general have refused to leave their homes because there was no planning about what to do with their pets. What we are seeing now is that these kinds of plans are being put in place so that when someone is called in to be deployed, their lives are put on hold. For them to function effectively, they must not be concerned about what is happening at home. Then they are able to devote themselves to the event. The planning needs to make certain that their affairs are in order. Their workplace should know what they need for some type of care in the home for dependent elders or children. Those types of things are part of their training — making certain that they are prepared to to get up and leave their lives.

This is not something that has been routinely taught as part of professional education of healthcare workers. This recognizes that they have multiple roles and their professional responsibilities can’t be in conflict with their personal responsibilities. Advanced recognition and knowledge about these potential conflicts should be part of the planning steps in place.

HEH: Do you recommend developing some kind of alternative communication plan?

Raveis: Yes. We know that in a disaster, one of the first things you try to do with anyone impacted is to help them connect with someone that is meaningful to them. If they are separated from their family, see if there is a way to get a message through to give them information. One of the things that can help build resilience is coming up with effective ways to make sure communication channels are in place. Everybody shared with us that they were really concerned about what was happening back home. When they did find out, they were able to relax and focus on the job at hand. One of the things is having communication available with people who are not in the disaster zone so there is a way to be able to connect or leave messages.

HEH: You mention planning for worst-case scenarios and sharing prior experiences with new workers.

Raveis: Try to prepare for the worst-case scenario and come up with multiple options. Then, if there are failures on one front, you have other options. The best thing is redundancy in systems because that allows for failure. Communication and backup resources are really key. It’s very helpful to explain the prior experiences to people who are just coming on board. These are the types of scenarios that could potentially happen, this is what we need to be prepared for, and this is what we have done in the past. In a disaster of any type, it’s the unknowns and the feeling like it is out of control and no one has ever faced this before — what do we do? With Sandy, what we found was that if someone was able to kind of pull from some prior experience, that made it a little easier for everybody.”

REFERENCE

1. Raveis VH, VanDevanter N, Kovner CT, et al. Enabling a Disaster-Resilient Workforce: Attending to Individual Stress and Collective Trauma. J Nurs Scholarsh 2017 Aug 14. doi: 10.1111/jnu.12329. [Epub ahead of print]