Disaster Management in Megacities: A Case Study from New York City

New York City (NYC), one of the great megacities in North America, is the most densely populated city in the United States (U.S.). One of every 36 people living in the U.S. resides in NYC, with 8.3 million people living in 322 square miles, or 27,000 people per square mile. Although there is a rich and complex medical and public health capacity, NYC confronts daily challenges of ensuring the effective functioning of its infrastructure, protecting the health of the population living in crowded quarters, and delivering emergency services in heavy traffic congestion.

With 67 acute care hospitals and multiples of community-based health care delivery systems, the coordination of preparedness and response is complex, at best, during an emergency. The blackout of 2003 challenged the entire public health and hospital system as it blanketed 85% of New York State with total loss of power for at least 30 hours. Historically, New York City has been a leader in actively implementing principles of public health preparedness. These principles were tested during the August blackout of 2003. We will review the challenges posed by this and other emergencies.