Leading in an Emergency

	HHC President Alan D. Aviles

In the aftermath of Hurricane Sandy, HHC President Alan D. Aviles shares his observations about this event and HHC’s recovery efforts.

Sandy was a storm like no other. Was HHC prepared?

Absolutely. We have invested a great deal of time, personnel, and resources into emergency preparedness planning. We have emergency management teams that plan for, drill for and refine our response to multiple disaster scenarios – blizzards, dirty bombs, mass casualty incidents, and of course, hurricanes too. But Sandy was an unprecedented event of monumental proportions, and confronted us with an unanticipated level of challenge. Nevertheless, we successfully orchestrated the safe and orderly evacuation of nearly 1,000 patients from two HHC hospitals. That success is a great indication of sound emergency preparedness planning and response - even when the unthinkable occurs.

Once you realized the full threat of the storm, what was your biggest concern?

I was at Coney Island Hospital when the full force of the storm hit. I watched as the surge pushed the water level high enough to flood the main floor of the building. That forced our hospital engineers to shut down both emergency generators before they shorted out. My concern was that we wouldn’t be able to fire those generators back up. There were nearly 200 patients in the house and twelve were on vents, and the vents were running on back-up batteries only. So when the water receded four hours later, I was very relieved that our engineers were able to re-start those generators.

What are your most vivid memories about that night?

My most powerful memory is about our staff. Sandy proved to be a ferocious storm. Naturally, we were all anxious about what could happen – to our patients, our families, our homes, ourselves. Yet I witnessed unbelievable bravery, professionalism, dedication and compassion from HHC staff. Despite their own fears, our staff members were exceptionally calm and reassuring as they continued to do what they do best – take good care of our patients. I will never forget that.

How did you reach the decision to evacuate Bellevue?

Evacuation of 700 patients is not a decision to come to lightly. A few hours after the storm subsided, some critically ill patients were evacuated down the stairs because pumps that carry fuel up to the four emergency generators on the 13th floor had failed. Staff ingeniously organized themselves into a bucket brigade to carry five-gallon containers of diesel fuel up to the generators, but the extensive damage to the hospital’s systems quickly became evident. It became increasingly clear that making even one elevator operable would take several days. What’s more, loss of water pressure required an already fatigued staff to carry pails of water up as many as 18 floors, to flush toilets. At that point, our senior team was unanimous that a complete evacuation was necessary.

You evacuated nearly 1,000 patients from two hospitals without incident. What went right?

Thankfully, it all went right. The logistics of this undertaking were very complicated, and the opportunity for error was great. But our staff focused exclusively on the safety of each patient. They planned for and carried out safe transport arrangements, and communicated important handoff information to the clinical teams at each receiving hospital. In several instances, our staff accompanied critically ill patients during transport, to personally insure a safe delivery.

Did you get any sleep during the event?

I got by with less sleep than I would have thought possible. The entire week after the storm seemed like one very long day. But I know that the same was true for many of my HHC co-workers.

Although power, heating and water systems were compromised at some sites, IT operations endured. Have our investments in technology paid off?

We have designed a great deal of redundancy into our information technology infrastructure, including two data centers that are each capable of running all of our mission critical IT applications. One data center is on the Jacobi campus, and the second is at a secure data facility in New Jersey. We did have to rely on some of the redundant capabilities across our IT system during and immediately after the storm, to maintain IT operations. So yes, those investments have clearly demonstrated their value.

Sandy caused serious damage to a number of HHC facilities. What needs to be fixed and how long will it take?

Obviously, repair, restoration and greater protections going forward will be a huge and complex job. First, we have focused on the fastest possible repair and restoration of essential service delivery, beginning with the re-opening of primary care services at both Coney and Bellevue, followed by limited emergency services. We’ll work round the clock to get full restoration of Coney by early January, and Bellevue by early February.

Once the two hospitals are up and running again, we will address the vulnerability of certain aspects of our physical infrastructure by re-positioning key equipment and systems to a higher elevation. This includes fuel and water pumps, air handling systems, power distribution panels, network IT switches, and other vulnerable core system components. Then, we will examine the possibility of surge protection measures, such as flood doors to seal off the loading dock entrance, or other diversionary systems that might limit the entrance of flood waters into the basement.

What’s your biggest takeaway from this experience?

The challenges and issues we face as we fully recover will be exceedingly complicated, difficult, and costly to resolve. But by far, the most enduring takeaway for me is the performance of our staff. I witnessed sound, effective leadership that was fully in charge of each local situation. I saw provision of services at the front lines of care that was extraordinary in its professionalism, ingenuity and compassion. I have always said that HHC’s greatest strength is our staff. That strength supported our patients, our mission, and each other, even as we faced an unprecedented challenge. We are HHC, and I couldn’t be more proud.

November 2012