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From evacuations to power outages to floods, nurses brave Sandy
In the midst of massive Superstorm Sandy, which battered the New York/New Jersey Metro region Oct. 29, Kimberly S. Glassman and her nursing staff were faced with a decision.
Glassman, RN, PhD, NEA-BC, senior vice president for patient care services and CNO at NYU Langone Medical Center in Manhattan, and her staff were on duty when the facility lost power during the height of the storm, between 8 and 8:30 p.m.
As planned, a backup generator went on to restore power. Unexpectedly, the backup power failed.
Without power and with water from the rising East River beginning to flood the hospital, "I knew right then we had to get out," Glassman said. "The nurses on every floor kicked in and prepared for evacuation. We probably had about 30 minutes."
Among the most dramatic aspects of the evacuation was moving NYU Langone’s smallest and most fragile patients — babies in the NICU. Transporting 20 critically ill newborns down nine flights of stairs was dangerous. Some of the babies had been on battery-powered ventilators to help them breathe. "The babies couldn’t be jostled because that would cause their oxygen levels to go down," Glassman said.
It was NICU nurse Menchu Sanchez, RN, who thought of a way to get them down safely, said Glassman.
"She’s the one who thought of taking the babies down in a warming pad, cradled in the arms of a single nurse to keep them warm and secure," she said.
Each nurse carried a baby down, close to her chest, surrounded by at least five staff members who held equipment, such as monitors and central lines, while lighting the way using cell phones and flashlights. "Everyone from secretaries to security guards were helping guide the babies down to safety," Glassman said. Air was manually pumped into the lungs of babies who required help breathing.
While the group slowly made its way down the nine flights, Glassman made sure they were ready to be received once they reached the ground floor. "I ran back down to the first floor to mobilize ambulances and staff at the foot of the stairs to get the stretchers right at the bottom of the stairs," she said.
In what Glassman called "divine intervention," the hospital was more than fully staffed at the time of the crisis because it happened during shift change.
"When we knew we were going to open our emergency command center, we alerted the staff and a lot of them came in Sunday [Oct. 28] and stayed," she said. "No one could get home, so Sunday night we housed about 300 people to be ready for Monday. We were very lucky that the power went out during shift change because we had double the amount of people."
The image of NICU nurse Margot Condon, RN, on a stretcher cradling an 8-hour-old newborn as she manually pumped air into its lungs was seen around the world via TV news outlets and the Internet, and was the catalyst for the attention given to the nurses’ quick thinking and determination.
"I just remember doing it," Condon said. "There was extreme concentration and extreme intensity — focus, focus, focus and stay calm, calm, calm — because when we get excited, the babies will get excited. At the same time, I’m watching the tube because I didn’t want to have to resuscitate the baby in the stairwell. I had 100% faith in my colleagues because they were doing their job just like I was."
In addition to a solo appearance on CNN and a joint appearance with her NICU colleagues on ABC’s "20/20," Condon and her colleagues appeared on "Katie" with Katie Couric and have been invited to Glamour Magazine’s Women of the Year event.
"It’s kind of a weird thing, and it’s not necessarily the nicest feeling," she said of the media attention. "It’s great for nursing and it’s great for NYU. That’s what’s driving me."
Condon’s image, Glassman said, allowed the world to see just how important nurses are and what they can do under the most dire of circumstances.
The nurses even received a call from President Obama, said Glassman, thanking them for their dedication.
"I am so proud of them … of how they just kicked into action," Glassman said. "We don’t do drills for going backward down a dark stairwell during a hurricane."
Some of the babies from NYU Langone were transferred to Montefiore Medical Center, said Susan Green-Lorenzen, RN, senior vice president of operations at Montefiore. Getting the babies moved quickly from NYU Langone to other waiting hospitals led to a positive unforeseen situation. Montefiore staff were ready to receive four babies, when six arrived at the hospital.
"Our nurses quickly came together to find space to accept the additional babies and their families," said Green-Lorenzen. "They needed our help and we weren’t about to turn them away."
The Montefiore nurses moved swiftly to get the babies settled, said Green-Lorenzen, then set about the task of making sure their families were taken care of, as well.
"Our nurses provided food and orange juice to the parents, as well as a room for them to rest after what was surely a traumatic experience," she said.
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The big move
Two NYC Health and Hospitals Corporation facilities — Bellevue Hospital Center in Manhattan and Coney Island Hospital in Brooklyn — also undertook evacuations.
On Oct. 29, Coney Island’s evacuation of about 270 patients because of flooding was successfully completed without complication, according to an HHC news release.
Bellevue was forced to evacuate hundreds of patients in the days after the storm when more than 17 million gallons of water had pooled in the facility’s basement.
Bellevue patients moved to neighboring hospitals as well as other HHC facilities, including Harlem Hospital Center and Metropolitan Hospital Center in Manhattan and Woodhull Medical Center in Brooklyn.
New York Downtown Hospital in lower Manhattan evacuated all its patients the day before the storm hit the area, choosing to do so while the hospital still had power and good weather.
Montefiore provided space for 50 patients evacuated from Bellevue.
The medical center is well prepared for emergency situations and power outages because it generates its own electricity at the main campus using a co-generation power plant, Green-Lorenzen said.
It also was prepared for the unpredicted gas shortage after the storm.
"We also run a fleet of cars using hybrid engines to reduce reliance on gasoline," she said.
To make sure it had enough staff to care for evacuation patients and their own inpatients, Montefiore nursing staff stayed overnight to ensure patients had continuity of care.
"We had hundreds of our staff spend the night across all campuses," Green-Lorenzen said. "At the Moses Campus, cots were set up in the great rooms of the hospital to provide our staff with a comfortable place to sleep. We also set up a movie screen and served snacks to try and help our staff relax after a busy day. Everyone was encouraged to get rest because we knew there was a lot more work to be done."
Like Montefiore, Mount Sinai Medical Center remained fully functional and was able to take on 64 patients from NYU Langone and 35 from Bellevue, including 12 psychiatric patients and 13 rehab medicine patients. To ensure adequate staffing, more than 1,000 nurses, physicians and support staff slept at the hospital overnight during the storm, according to a hospital news release.
Denise Nepaulsingh, RN, a nurse in the PACU at Mount Sinai, was on hand the night of the storm and helped with the transfer of patients from NYU Langone.
"My director, Geralyn McDonough, RN, asked six nurses to remain overnight in case our critical care skills would be needed elsewhere in the hospital," she said. "At about 9:30 p.m., we received word that NYU Langone would be evacuating 30 critical care adult patients and 11 critical care pediatric patients."
Mount Sinai has three PACUs, she said, and they quickly got two of them ready to receive patients.
"All of the nurses, along with my director, set up 25 critical care bays in the main PACU for the adult patients. In another PACU, we set up 11 bays to receive the pediatric patients," she said.
The team worked furiously to set up the necessary cables, suction equipment and ventilators.
"At around 12:30 a.m., the patients started arriving and were transferred and hooked up to monitoring immediately," she said.
NYU Langone staff stayed to get patients settled in and to provide continuity of care.
"The teamwork was amazing," Nepaulsingh said. "It was quite an impressive sight to see NYU nurses and physicians working along with the Mount Sinai nurses and physicians, all for the good of the patients."
The transfer took about 3-1/2 hours, and throughout the night everyone stayed focused, calm and positive.
"I witnessed the best of the human spirit and what we are all capable of when we work together in times of emergency," Nepaulsingh said.
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One hospital stood alone
While its neighbors in lower Manhattan endured evacuations, power failures and flooding that forced them to close their doors, Beth Israel Medical Center continued to care for patients during one of the worst storms in history.
Called "the last hospital standing" by the New York Daily News, the Continuum Health Partners facility was able to remain open and fully functioning during the entire storm — at near capacity and running on generator power alone.
Because it was one of the only hospitals in the area open during the storm, the ED was bursting at the seams with people who needed assistance, said Colette Russen, RN, an ED staff nurse.
"Most of the evacuated patients from New York Downtown, NYU Langone and Bellevue went to other hospitals, leaving us open for neighborhood patients," she said. "We got all of the ambulances and the elderly and infirm, those on oxygen compression machines. All had to be admitted because there was no power."
With no other choice, patients went to the ED seeking replacements for medications they had lost as a result of the storm.
"A gentleman who had been caught in a flood came in because his medications were soaking wet," Russen said. "We also had a patient with a relatively new diagnosis of end-stage metastatic cancer who was supposed to be going to hospice come into the ED. He was frightened because he didn’t know what to expect, so it was very important that we had staff to take care of him, to talk to him and help him feel better, not leave him in a corner and forget about him."
With so many patients and staff forced to stay put during the storm, the hospital opened additional units for the patients and closed part of the ED for staff sleeping quarters.
"We slept on stretchers, but everyone was in good spirits and encouraged each other," said Russen.
In a lesson learned during Hurricane Irene the previous year, Russen remembered one important detail.
"My pillow," she said.
In another part of the hospital, Hyacinth Hamilton-Gayle, RN, MSN, PNP, clinical director of maternity and psychiatry, and Gloria Wynter, RN, a staff nurse on the mother-baby unit, were making sure babies and their moms were safe and secure.
"Several patients who came from Downtown and NYU Langone ended up delivering with us," Wynter said.
The nurses also cared for patients who were brought in by EMS for obstetrical care.
"Many of the OB nurses came prepared to stay, and at least five of them stayed over for three days," Hamilton-Gayle said.
To ensure they got the same care as all Beth Israel mother/baby patients, some of the visiting physicians were trained on the PeriBirth labor and delivery medical record system.
"We had a PeriBirth trainer right on site to train them so that they would be able to help," Wynter said.
Well babies are usually seen two or three days after discharge, but because ambulatory services were closed, a new plan had to be set up to allow for follow up. "The physicians and nursing team had to come up with a plan to determine where we could see them here," Hamilton-Gayle said. Together, they set up a unit area where babies could be seen on the days following the storm.
"The first mom we saw on Saturday had no electricity at home and she was so excited to be here," Hamilton-Gayle said. "She was very happy to be able to come back and let us take care of her and the baby."
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As news reports of Superstorm Sandy’s approach commandeered the airwaves, healthcare facilities across the region took the necessary precautions to ensure patients and staff would be safe.
Facilities seaside on Long Island and in New York City’s Zone A — Manhattan’s lower east side and parts of Brooklyn, Queens, Staten Island and the Bronx — were forced to evacuate patients because of anticipated storm surges.
Long Beach (N.Y.) Medical Center and Long Beach nursing homes moved patients to Nassau University Medical Center in East Meadow, N.Y., not assuming that the coastal community on Long Island would go unscathed.
NUMC, a NuHealth facility, had taken Long Beach patients in 2011 during Hurricane Irene, and took lessons learned from that experience to make this one go even smoother, said Janice Pateres, RN-BC, MS, MBA, director of nursing for med/surg services.
"We did preliminary registrations for patients and set up transport teams this time," she said. "Once patients were assessed and their destinations were determined, we were able to transport them more quickly. This allowed us to get 20 psych patients settled in about an hour."
NUMC also took 37 med/surg patients from Long Beach, while 35 nursing home residents were transported to NuHealth’s A. Holly Patterson Extended Care Facility.
"We also received patients with chronic conditions from shelters," Pateres said.
At another Long Island facility, John T. Mather Memorial Hospital in Port Jefferson, N.Y., evacuations and receiving other patients were not needed, said Liz Contre, RN, BSN, a med/surg staff nurse, but the hospital was ready just in case.
"The Friday preceding the storm, a list of available staff was made in case there was an influx of patents from other facilities," Contre said. "Our nurses banded together so our patients wouldn’t suffer."
Thousands on Long Island lost power during the storm, and many still were in the dark a week later.
"[Lack of] lights in the patients’ rooms was handled seamlessly ahead of time by our administration, who contacted Home Depot and bought lamps and flashlights for each room," Contre said. "For safety purposes, the critical care staff took ventilator-dependent patients from the med/surg units to the intensive care unit."
No power meant no computer use, so staff had to go back to written notes and documentation. "We were prepared to use paper during the down time," Contre said. "That was the biggest lesson we learned from Irene."