Assessing the damage: Evaluating the outcomes of Hurricane Sandy on patients and nurse utilization in a NYC academic medical center

Introduction: Preparing and planning for catastrophic disasters, such as earthquakes, nuclear accidents and other man-made or natural disasters, require decisions about whether and when to shelter or evacuate patients from hospitals. The disease and emergency literature regard the avoidance of both patient mortality and morbidity, as well as appropriate utilization of nursing resources for safe evacuations and deployment to other settings, as critical to such decisions. Methods: Analyzing administrative and qualitative data, this presentation examines how one NYC-based academic medical center managed patient care during Hurricane Sandy, when established disaster plans, based on hazard vulnerability analysis, required continual adjustments. Results: In anticipation of the storm, the hospital discharged large numbers of patients to skilled nursing facilities and home (with and without home care services). Patients deemed too ill to leave were sheltered in the facility (n= 322, representing 40 percent of original census). In light of quickly changing circumstances, sheltered patients were evacuated during the storm to 12 local hospitals; 7 percent of evacuees went to skilled nursing facilities. Over eighty-five percent of the RN workforce (n=1289) were redeployed to care for evacuated patients in other hospitals and ambulatory sites. Literature on mortality rates associated with hospital evacuations during storms is scant. However, in comparison to reported mortality rates associated with storm-related nursing home evacuations, no fatalities occurred during or immediately after evacuation. Conclusions: Ongoing attention to patient outcomes and nursing utilization was crucial to decisions whether to shelter or evacuate hospital patients during Hurricane Sandy.