Hospital Evacuation and Shelter-in-Place During Hurricane Sandy – An Analysis of Influential Mid-Atlantic State Laws

During recent catastrophic hurricanes including Katrina and Sandy, essential hospital services such as power, steam, water, and sanitation were interrupted hindering continuity of patient care and threatening the safety of patients and staff. Because a fundamental duty of government is to protect the health and safety of its citizens, the government has a responsibility to ensure appropriate protective action – including shelter-in-place or evacuation – is taken when impending disasters impair the ability of hospitals to sustain essential services. Public health legal preparedness plays an essential role in enabling the government to fulfill its duty by providing the necessary legal framework to respond to catastrophic disasters. Utilizing an electronic legal database, statutory and administrative codes for Delaware, Maryland, New Jersey, and New York were searched to identify laws in place on October 22, 2012 (the date Hurricane Sandy made landfall) concerning the government’s authority to order evacuation or shelter-in-place. Data were systematically abstracted from resulting state laws to describe and compare the public health legal preparedness of Mid-Atlantic states during Hurricane Sandy. At the time of Hurricane Sandy, none of the four Mid-Atlantic states explicitly authorized the government to order shelter-in-place. While all four Mid-Atlantic states had enacted laws enabling the government to order evacuation, the nature and scope of this authority varied. Empirical recommendations to ensure the Mid-Atlantic region is better able to protect public health during future natural disasters, which are predicted to be more severe and frequent as a result of climate change, will be presented.