DiversityNursing Blog

By Alex Crees

In anticipation of a forecasted Nor’easter – expected to usher in rain, snow and high winds to states already struggling to pick themselves up in the wake of superstorm Sandy – a mobile emergency department is bringing much-needed help to local hospitals.

Hosted by Hackensack University Medical Center, in Hackensack, N.J., the New Jersey Mobile Satellite Department has been deployed twice already in the past week-and-a-half at the request of the state health department.  

The mobile ER is made up of 15 trucks, including three large ones used as treatment areas.  There are also special trucks to produce oxygen and interconnect the vehicles. The trucks are ‘full-service’ ERs with monitor beds, ultrasound capabilities, pharmaceutical reservoirs and an entire support team of doctors, nurses and technicians.  In a 24-hour period, the service – including equipment, personnel and supplies – costs approximately $15,000.

“On the outside, they look like box trucks,” Dr. Joseph Feldman, the chairman of emergency services at Hackensack told FoxNews.com. “But from the inside, you would never know you were in a truck.  You would think you were in a state-of-the-art emergency department.”

According to Feldman, the 43-feet long trucks were designed as a prototype five years ago, funded by the Department of Defense to be designed and built as the hospital saw fit.  

“They can be rapidly deployed within an hour of driving to a place,” he said.  “We designed them in a way so they can be maneuvered in urban and suburban areas and set up [quickly].”

The first time the mobile ER was deployed this year, it was to New Jersey’s Somerset County, the Sunday before Sandy made landfall.  In 2011, the county was flooded by Hurricane Irene, and medical personnel were unable to move in and out of the area.

“We were requested to pre-deploy to that area, so we saw a bunch of patients there – we even delivered a premature baby,” Feldman said.

The mother, he explained, had had a ‘harrowing’ experience arriving at the site.  

“The initial ambulance go stuck in the mud, so they had to transfer her to a police vehicle, and then another ambulance [brought her to the site],” Feldman said.  “Because of high winds, we took the equipment to a church hall and did an ultrasound…We were able to deliver her in a very safe environment, and it was a healthy baby boy just over five pounds.”

The mobile ER was then re-deployed later in the week to Brick, N.J., to support Ocean Medical Center and three other hospitals in the area.  As of Monday, the mobile site had seen more than 150 patients, alleviating the burden of nearby emergency departments experiencing a massive surge in patients.

Dr. Doug Finefrock, the vice chairman of Hackensack’s emergency department said he was able to take care of a young women who had waited 10 hours at a local ER and couldn’t be seen.  

The woman, who was pregnant, was suffering from abdominal pains and was worried she was suffering a miscarriage.  She hadn't yet seen an OB-GYN, so Finefrock did an ultrasound and was able to determine the pregnancy was fine and show her the baby's heartbeat for the first time.

The mobile operation was supposed to end Tuesday, Feldman explained; but due to an incoming Nor’easter, the state’s DOH has requested the hospital keep its assets in place and monitor the situation through Thursday.  According to Feldman, the trucks, which can run on generators or landlines, can be set up indefinitely.

Due to the utility of the mobile ER in the aftermath of Sandy, Feldman said “we’ve gotten a lot of interest around the country, inquiring about our assets and how they work, not only from medical centers but other government agencies…On a good day, ER rooms are congested and crowded; add a disaster on top, and it’s much worse. These vehicles, along with a tent hospital, allow communities to expand emergency service and provide needed health care to citizens.”

By JOHN LELAND

Published: November 1, 2012

As two burners on his stove provided warmth on Thursday, Suzanne Gilleran, 47, carefully cut the gauze around Mr. Oberlin’s leg. “How’s your pain today?” she asked. “Did you take anything?”

As parts of the city edged toward some semblance of normal on Thursday, tens of thousands of people like Mr. Oberlin, who depend on essential home medical care, remained tenuously connected to lifesaving services by agencies like Partners in Care, an affiliate of the Visiting Nurse Service of New York.

At the Visiting Nurse Service of New York alone, more than 5,000 nurses, aides, social workers and others were out serving patients around the city during and after the storm.

Nurses and home aides, who often earn minimum wage or just above it, had to make a decision: go out in the storm or its aftermath, possibly risking their lives and ignoring conditions in their own homes, or make life possible for the patients depending on them.

“I saw six patients yesterday,” said Ms. Gilleran, who trains nurses at Partners in Care, and does not ordinarily make home visits. But because of Hurricane Sandy, the agency pressed all available registered nurses into field duty, as did other agencies around the city, often sending them into conditions made difficult by the weather: the power failures, the lack of public transit, the traffic.

It took Ms. Gilleran three hours on the express bus from Forest Hills, Queens, to get to Mr. Oberlin. Then there were the stairs. The lowest patient “was on the fourth floor,” she said, “the highest was on the 14th.”

“I realized,” she added, “I walked halfway up the Empire State Building, and most of the stairwells were pitch black.”

Allison Chisholm, 46, who works for the Visiting Nurse Service, lives with a frail mother in Park Slope, Brooklyn. When the lights started flickering during the storm on Monday, she had images of her mother falling in the dark. But she also had patients who needed her, including one receiving hospice care in a 12th floor apartment in Chinatown, and one needing an intravenous round of antibiotics in the West Village.

“It was treacherous driving during the hurricane,” said Ms. Chisholm, fitting an intravenous line into the arm of Jill Gerson, 71, who teaches social work at Lehman College in the Bronx. “But it’s just something you have to do as a nurse. That continuity of care helps the healing. I don’t see this as being heroic. I have a conscience. I need to get to sleep at night.”

Dr. Gerson had been hospitalized twice — first as a result of complications from a dental implant, then because of a reaction to her antibiotics. If she missed one day of antibiotics now, she would probably be all right, but two or three days could be life-threatening.

Dr. Gerson, who lives in the West Village, close to the Hudson River, stayed in her home rather than move in with friends, even as the water flowed down her street and into her basement.

“This woman has been saving my life,” she said, pointing to Ms. Chisholm.

Ghislaine Chery, 50, provides home care to patients at two housing projects in the Rockaways; under normal circumstances she travels with a guard. When the storm approached, and the Rockaways were subject to mandatory evacuation, she talked with her clients about leaving.

“After Irene, many of them had had to wait several days for buses to return, and they didn’t want to go through that again,” Ms. Chery said in a telephone interview. So they stayed — blind and in wheelchairs, blind and diabetic — counting on Ms. Chery, who lives on Long Island, to reach them with their medications and other essential services.

“I was here by 7:45 Tuesday morning,” Ms. Chery said. “I’ve been seeing 8 or 10 patients every day. It’s been a real experience.”

As the recovery drags on, a growing need is for mental health care. Scott Feldman, a social worker for the Visting Nurses, answered a call on Wednesday night for volunteers on Staten Island, where he lives. When he arrived at Tottenville High School, which was serving as a temporary shelter and evacuation center, he was directed to a couple in severe distress.

“They’d seen cars coming up their street, not being driven by anyone, just by the flood,” Mr. Feldman said. “They’d lost everything.” Then they tried to help another couple across the street, but had only been able to save the woman, Mr. Feldman said. “The wife was sleeping when I got there. The husband was waking up every hour screaming. So now what do they do?”

At Mr. Oberlin’s apartment, as Ms. Gilleran prepared to leave, taking the trash with her, Mr. Oberlin, who was a well-known countertenor and founding member of the New York Pro Musica Antiqua ensemble, beamed. “I can’t get over this service,” he said. “At the same time, I can see how expensive it must be.”

Dr. Gerson had a different opinion: “This service saves a fortune, because we don’t have to be in hospitals. They don’t pay these people enough.”

Ms. Chisholm waited patiently for the antibiotic drip to finish. She had a long way to go from the West Village back to Park Slope.

By ANEMONA HARTOCOLLIS and NINA BERNSTEIN

Published: November 1, 2012

Officials rushed to move the most critically ill patients closer to an emergency generator. After midnight, doctors heard shouts in the hallway. The basement fuel pumps had stopped working, and medical residents, nurses and administrators formed a bucket brigade to ferry fuel up 13 flights to the main backup generators.

By Tuesday, the elevator shafts at Bellevue, the country’s oldest public hospital, had flooded, so all 32 elevators stopped working. There was limited compressed air to run ventilators, so oxygen tanks were placed next to the beds of patients who needed them. Water faucets went dry, food ran low, and buckets of water had to be carried up to flush toilets.

Some doctors began urging evacuations, and on Tuesday, at least two dozen ambulances lined up around the block to pick up many of the 725 patients housed there. People carried babies down flights of stairs. The National Guard was called in to help. On Thursday afternoon, the last two patients were waiting to be taken out.

The evacuation went quickly only because Bellevue had planned for such a possibility before Hurricane Irene hit last year, several doctors said. But the city, which had evacuated two nearby hospitals before that storm, decided not to clear out Bellevue. In the wake of Hurricane Sandy, the consequences of bad calls, bad luck and equipment failures cascaded through the region’s health care system, as sleep-deprived health care workers and patients were confronted by a new kind of disarray.

A patient recovering from a triple bypass operation at Bellevue walked down 10 flights of stairs to a waiting ambulance, one of the dozens provided through the Federal Emergency Management Agency to speed patients across the metropolitan region.

Mount Sinai Medical Center, already dealing with the 2 a.m. arrival of a dozen psychiatric patients who spoke only Chinese, was struggling to identify the relatives of brain-injured traffic victims from Bellevue who arrived three hours later with only rudimentary medical records.

Maimonides Medical Center in Brooklyn was straining to meet a rising need for emergency dialysis for hundreds of people shut out of storm-crippled private dialysis centers. Patients who would normally get three hours of dialysis were getting only two, to ensure the maximum number of people received at least a minimal amount of care.

“The catastrophe is growing by the minute,” said Eileen Tynion, a Maimonides spokeswoman. “Here we thought we’d reached a quiet point after the storm.”

Every hospital maintains an elaborate disaster plan, but after Hurricane Sandy, the fact that many health care facilities are in low-lying areas proved to be something of an Achilles’ heel. Bellevue became the third hospital in the city to evacuate after the storm’s landfall, after NYU Langone Medical Center, just north of Bellevue, and Coney Island Hospital, another public hospital.

New York Downtown Hospital, the only hospital south of 14th Street in Manhattan, and the Veterans Affairs Hospital, just below Bellevue, had evacuated before the storm.

Hospital executives were reluctant to criticize their colleagues or city officials. But the sequence of events left them with many questions.

“All hospitals are required to do disaster planning and disaster drills,” Pamela Brier, the chief executive of Maimonides, noted. “All hospitals are required as a condition of being accredited, to have generators, backup generators.”

City health department and emergency officials have been particularly fervent about citywide disaster drills, she added, but “as prepared as we think we are we’ve never had a mock disaster drill where we carried patients downstairs. I’m shocked that we didn’t do that. Now we’re going to.”

The city’s health commissioner, Dr. Thomas Farley, defended the decision not to require evacuations of Bellevue, Coney Island and NYU Langone hospitals before the storm, which he said had been made in consultation with the state health commissioner, Dr. Nirav Shah.

Dr. Farley said they based the decision on their experience with Hurricane Irene, when they ordered the evacuation of hundreds of patients from six hospitals, including NYU Langone, and a psychiatric center, as well as of thousands of residents of nursing and adult homes.

“We saw there was definitely risks to patients from evacuations,” Dr. Farley said.

He added that, “As the storm got worse on Sunday, we did recognize that there would be some risk to health care facilities, so we took some steps to make sure that they were aware of that.”

But he said he considered the decision to wait a success overall: “There was no loss of life as a result of those evacuations.”

He said the city was still assessing what to do differently next time. “We certainly are seeing many more severe weather events in this city than we’ve seen in the past, that does mean we have to rethink the vulnerability of our health care facilities,” Dr. Farley said.

A major concern for hospitals is that traditionally, generators, fuel tanks and fuel pumps have been located in their basements. Both NYU Langone and Bellevue had actually shored up their defenses after Hurricane Irene, according to executives of both hospitals. Among other changes, both built flood-resistant housings for their fuel pumps.

But some circuitry, as well as tanks and pumps, remain on low floors, making backup systems vulnerable. The equipment is enormously heavy, so putting them on higher floors would require a great deal of reconstruction and possibly changes in building codes, said Dr. Steven J. Corwin, the chief executive officer of NewYork-Presbyterian Hospital, which has been taking on extra patients and bringing in extra staff.

Another serious issue is how long a hospital should expect to rely on a generator if the power fails.

“Heretofore, it was felt that generator power would be for a self-limited time, not more than a day — two, three at the outside,” Dr. Corwin said. “Now we’re looking at events where it could be a week.”

Alan Aviles, president of the Health and Hospitals Corporation, which runs the city’s public hospitals, said that all signs pointed against a storm emergency. “Up until an hour before the storm made landfall, the National Hurricane Center was saying that there was only a 5 percent probability of a storm surge over 11 feet in the area that would impact Coney Island, and they weren’t even showing a 5 percent probability on the East River,” Mr. Aviles said.

When the main power went off about 9 p.m. Monday, doctors and nurses were initially told not to worry, because the backup generators were working fine, people there at the time said. But by about 10 p.m., the basement was completely flooded, the pumps were flooded, and doctors were warned that they could lose backup power very shortly.

Critical-care doctors and nurses immediately began moving their patients to the area served by a lower-floor generator. Everyone moved quickly to disconnect patients from respiratory machines and then reconnect them.

A Bellevue doctor said midlevel administrators began begging their bosses to evacuate the hospital Monday night, when water could be heard pouring through the elevators, “like Niagara running through the hospital.”

“The phones didn’t work,” he said, speaking on the condition of anonymity for fear of being fired. “We lost all communication between floors. We were in the dark all night. No water to wash hands — I mean, we’re doctors!”

When the evacuation began, patients were bundled into red and orange sleds and dragged down as many as 13 or 15 flights of stairs. “If they were ventilated, someone was dragging them with a bag” of hand-pumped oxygen, one doctor said. “It was a herculean effort.”

Despite the power problems, Bellevue was able to print out some medical records or get summaries from doctors to send with patients. But landlines and cellphones were affected, and doctors and nurses said they wished some other form of communication, like walkie-talkies, had been available.

It was not until Wednesday, Mr. Aviles said, that everyone realized the situation was beyond repair and the final decision to evacuate everyone was made. “It was at that point that it was clear that it was just not tenable to keep patients for a longer term in the hospital,” he said. “We know that all these patients were successfully transferred to safety and are doing well, and I think that’s what’s important.”

 By KATIE MOISSE (@katiemoisse) Nov. 1, 2012

Among all the rescues carried out during the chaos caused by Sandy, the most delicate was the mission to save embryos in rows of incubators that were in jeopardy when the NYU Fertility Center lost its power.

The Manhattan clinic lost power shortly after Sandy struck Monday night. A generator perched atop the 8-story building kept incubators running through the night, but flooding in the basement cut off its fuel supply.

"The generator ran out of gas around 8:15 Tuesday morning," said Dr. James Grifo, the clinic's director.

Without power, the incubators housing delicate embryos at womb-temperature for in vitro fertilization began to cool. But Grifo and his team took action, hoisting five-gallon cans of diesel fuel up darkened stairwells to feed the failing generator.

"It was really a privilege to be part of that," Grifo said of his staff's "heroic" efforts.

The fuel bought the team enough time to transfer the embryos into liquid nitrogen, where they can be stored indefinitely.

The embryos were secured as another urgent issue arose.

At 10 a.m., a patient arrived for an egg retrieval -- a surgical procedure timed down to the hour after a two-week run of expensive fertility drugs.

Grifo loaded the woman into his car, along with her husband and their baby, and rushed them to a colleague's clinic uptown.

"It's amazing what people can do when everyone's on the same page," Grifo said, adding that the rest of the clinic's patients were booked into clinics throughout the city to "salvage" their cycles.

"It's a testament to the people in New York who work in medicine," he added. "Some of our most vicious competitors offered assistance."

Sandy spawned record-breaking tides around lower Manhattan, prompting power outages from East 39th Street to Battery Park at the southern tip of the island. The NYU Fertility Center is on First Avenue and 38th street, just a block from the overflowing East River.

The storm forced the nearby NYU Langone Medical Center to evacuate 300 patients in gusts of wind topping 70 miles per hour. Cells, tissues and animals used for medical research were left to die in failing refrigerators, freezers and incubators.

But thanks to Grifo and his team, eggs and embryos at the fertility clinic were spared.

"Hopefully we'll get some babies out of it, and that'll be a nice story as well," he said.

Sandy was an example of what some fertility clinics call an "act of God," an unfathomable tragedy that patients are warned about before starting the IVF process.

"There's so much riding on this," said Dr. James Goldfarb, director of the University Hospitals Fertility Center in Cleveland. "Even when everything's going smoothly, it's stressful for women. But add the stress of having to start all over again, that's extremely stressful."