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At Bellevue Hospital, All Hands on Deck During Hurricane Sandy

Editor’s Note: After Hurricane Sandy flooded the lower floors of Bellevue Hospital Center, N.Y., with 10 million gallons of water, rendering the fuel pumps for the center’s back-up generators useless and many of the nursing units without power, the nation’s oldest public hospital was forced to do something no one in its 276-year history ever anticipated: Evacuate or discharge every single patient. Michael Blumenfeld, R.Ph., M.B.A., director of pharmacy services, spoke with InterSections about the days leading up to the evacuation and the challenges the pharmacy team faced.

National Guard troops were deployed to help evacuate patients from Bellevue Hospital in Lower Manhattan to other area hospitals.

Q. How did the pharmacy staff prepare for the storm?

We began planning as soon as we were aware that the storm was on its way. We knew we had to ensure that we had enough medications and staff to get through three or four days of intense weather. I contacted our wholesale representative and arranged to have our usual Monday delivery on Sunday. Our assistant director in purchasing also had been ordering supplies through the week, which supplemented the Sunday delivery.

In addition to our regular staff, about 20 pharmacists and 14 pharmacy technicians made themselves available to help during the storm. There were two sets: Those who lived close by and could walk to the hospital, and those who had to take refuge in the hospital on cots. They knew that once they were here, they were here for the duration.

Q. What were your procedures during the storm?

We operated in shifts, with six hours of sleep each. The management team slept in offices in the chairs for an hour or two a night. We had power for the first 24 hours, Sunday into Monday, and then on Monday, the lights went out. The emergency power wouldn’t come up. Most of the circuits just weren’t operational.

Our staff managed to find a working outlet in one of the clinical offices. With extension cords from our engineering department, we jerry-rigged four computers, which were manned by rotating pharmacy staff to verify orders and review patient profiles. Once the phones went out, orders would go from the office carried by teams of people. We had technicians going around the pharmacy with flashlights pulling the drugs. Then, teams of volunteer runners would bring the meds to the floors.

We closed our satellite pharmacies and deployed pharmacists to critical care and most med-surg specialty areas. They communicated through runners or came to the pharmacy to get the medications themselves. There was not one day when they didn’t manage. Many of them worked 16 to 20 hours per day. I had to send staff away to sleep for fear they were too tired to work.

Q. What happened during the evacuation that Wednesday?

First, we discharged patients who were ready to go home. For the rest we provided five-day doggie bags of their medications to make sure the continuum of care wouldn’t be interrupted. We knew other facilities may not have had the same formularies and would need time to either borrow medications from us or purchase them from their distributors.

By Thursday evening, all patients were out of the hospital, down from a patient census of more than 700. As we left on Friday, I passed people with tears in their eyes. For the first time in 276 years, Bellevue had no patients.

Pharmacy staff joined other health care workers to help move patients.

Q. Do you have any words of advice for other pharmacists or pharmacy directors regarding disaster preparedness or functioning during a disaster?

Take the advisories seriously. Look at it from every point of view. Most disaster plans are along the lines of “if this fails, then we do that, and if that fails, then we do this.” Make sure that your plans work with a complete failure of all your systems. It doesn’t sound possible, but we lost everything.

Think of what would happen if patients had to be transferred out. How will you ensure the continuum of care? If you decide to send doggie bags, how many days will they cover? How will you communicate with other facilities? Have the discussion once a year, whether you live in a disaster-prone area or not.

–By Terri D’Arrigo