Blackout creates influx of patients, generator woes

Few traumas, more car wrecks and vent patients

When the lights go out, brace yourself for a surge in patients even if things seem relatively peaceful. That was the lesson learned during the blackout that recently crippled the northeastern United States.

Though the crisis ended peacefully, without the feared violence in the streets, most EDs in the New York City area reported a fourfold increase in ED visits, says Monica Mahaffey, spokeswoman for the Rensselaer-based Healthcare Association of New York State.

When the New York City-based Greater New York Hospital Association queried member hospitals about how they were coping with the blackout, ED volume was always a major concern, says spokeswoman Mary Johnson.

"We don’t have hard data yet, but the majority said they were definitely seeing an increase in volume," she says. "The answers ranged from bursting at the seams’ to 30% above normal,’ to very busy, but we’re handling it.’"

Here are some of the lessons you can learn from their experiences:

• People will need your electrical power and medications.

A lot of people came to plug in their ventilators because they had no power at home, Mahaffey says. Mothers came in for baby formula because they were afraid theirs had spoiled, and diabetics came in for food, she says. "Then they saw a lot of people who were trapped in subway cars and the usual people who tripped in the dark and had minor fractures," Mahaffey says.

One hospital turned one of its ED waiting areas into a holding area for ventilator patients and others who just needed to plug in their electrical devices to the hospital’s power, she says.

Some people came to the ED just for a cool drink of water, and some nursing homes had to transfer patients to hospitals when their own backup generators failed or were unable to support air conditioning. Heat-related illnesses also sent many people to the ED for help. Some patients came to the ED when they couldn’t obtain their prescription medications from closed pharmacies.

• Prepare for an increase in car accidents and food poisonings.

JoAnne Tarantelli, executive director of the New York chapter of the Irving, TX-based American College of Emergency Physicians, confirms that "there definitely was increased volume" at area EDs, including some car accidents that happened when the traffic lights went dark.

In the days after the blackout, Tarantelli and others heard stories that there were increased incidents of food poisoning, from people eating food that should have been destroyed. "People started showing up with flulike symptoms that turned out to be food poisoning," Tarantelli says. "So there was increased ED volume both during the blackout and after."

When the blackout happened, EDs first saw patients from motor vehicle accidents start to roll in, then the elderly who couldn’t handle the heat, and then those whose nebulizers or oxygen wouldn’t work without power at home, Tarantelli says. During the evening, the volume increased at a steady pace, she says.

• Prepare to be without your utilities.

Some facilities had difficulty getting their generators on line and were saved only by the fact that power was restored within hours to some parts of the community. Before it was known how long the crisis would last, others realized that their fuel supply for the generator might not last as long as they needed it.

Most hospitals in the New York area revamped their emergency plans after 9/11, and the blackout put many of those contingencies to the test, Johnson notes. Most found that their plans were sufficient, but some hospitals struggled with a lack of water and sewage services.

One such hospital was Lockport (NY) Memorial Hospital, where Susan Wendler, director of development and community relations, says the ED had to go on diversion for a short time.

The power went off about 5 p.m. and returned about 8:45 p.m. The hospital’s generator provided backup power without difficulty, but the city of Lockport was unable to provide water pressure.

"That was the most serious thing for us to deal with. We couldn’t use toilets and had to limit our overall water use to preserve our emergency supply of water," she says. "We had to divert our emergency department for a very short time while we were refilling the water supply to our radiology X-ray processor."

Wendler says her ED learned to stock more flashlights, fans, and waterless hand sanitizers.

• Use extra staffing and volunteers.

ED volume was up at Lockport, just like it was everywhere else, but medical staff from other departments pitched in to help with suturing and similar tasks. Staffing was made easier by the timing of the blackout, which was in the afternoon before the day shift had gone home. Volunteers also helped manage the influx of patients in the ED.

"We had people who came to the hospital to use the facilities, like going to the bathroom or just cooling off," she says. "They didn’t really need ED care, but the ED was the point of entry for most of those."

• Stay aware of potential violence.

St. Barnabas Hospital in Bronx, NY, initiated its emergency plans because it is in a heavily populated area. As darkness fell, the ED staff braced for looting and other violence in the streets and prepared for a surge in injured patients. But those patients never showed up.

The ED staff stayed in close contact with the local police precinct, but much of their news about the blackout came from ambulance crews. When an ambulance came in, the ED staff peppered the crew with questions about what they had seen out on the streets and how bad the situation was. In turn, the patients coming to the community asked the same questions of the ED staff.

• People will come for encouragement.

Mahaffey says the type of patient coming to the ED that night was different from what ED managers usually see. In many cases, they just needed reassurance, she says.

"We found out that communities look upon their hospitals not only for medical care but also for comfort, shelter, and solace," Mahaffey says. "When disasters happen, a lot of people run to the emergency room."

The ED will always be a focus of activity in a situation such as a blackout, says Jerry Balentine, DO, medical director at St. Barnabas.

"It’s the entry point for the hospital, especially when people are scared and there is an unusual situation," he says. "People looked to the ED for help, and we learned that we have to be ready to give that kind of assistance. It’s a different type of demand on the ED from what we practice for in a disaster drill that focuses on large number of injuries and trauma."

Sources

For more information on handling blackouts, contact:

  • Jerry Balentine, Medical Director, St. Barnabas Hospital, Third Ave. and 183rd St., Bronx, NY 10457. Telephone: (718) 960-9000.
  • Mary Johnson, Spokeswoman, Greater New York Hospital Association, 555 W. 57th St., 15th Floor, New York, NY 10019. Telephone: (212) 246-7100.
  • Monica Mahaffey, Spokeswoman, Healthcare Association of New York State, One Empire Drive, Rensselaer, NY 12144. Telephone (518) 431-7600.
  • JoAnne Tarantelli, Executive Director, New York Chapter of the American College of Emergency Physicians, 1070 Sibley Tower, Rochester, NY 14604. Telephone: (585) 546-7241.
  • Susan Wendler, Director of Development and Community relations, Lockport Memorial Hospital, 521 East Ave., Lockport, NY 14094. Telephone: (716) 514-5700.