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Collaborative effort weathers storm

Hurricane Irene tests New York City nursing staff amid mandatory evacuations

Monday September 12, 2011
Mount Sinai's Lindsay Condrat, RN, clinical nurse manager, left, and Song Lee, RN, a nurse clinician on 14E at NYU Langone Medical Center, worked side by side during the hurricane.
Mount Sinai's Lindsay Condrat, RN, clinical nurse manager, left, and Song Lee, RN, a nurse clinician on 14E at NYU Langone Medical Center, worked side by side during the hurricane.
(Photo by Sonia Zabala)
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With torrential rains and 80 mph winds, Hurricane Irene tore up the East Coast the last weekend of August. Although it had been downgraded to a Category 1 storm, public officials in the New York area took precautionary steps by implementing mandatory evacuations of hospitals and nursing homes in low-lying areas. That action prompted the transfer of hundreds of patients to healthcare facilities that were more than ready to handle the influx.

Patients go out

An executive order given Aug. 25 by New York City Mayor Michael Bloomberg called for the evacuation of residents in the city's low-lying Zone A areas (see sidebar). It also required all senior centers, nursing homes and hospitals in those areas to evacuate patients by 8 p.m. Aug. 26. The order included the removal of about 270 patients from Coney Island Hospital in Brooklyn.

"We were all awaiting the mayor's word," said Terry Mancher, RN, MSA, NE-BC, Coney Island's CNO. "Alan Aviles, president of [New York City Health and Hospitals Corporation], notified our executive director, Arthur Wagner, who then notified the executive staff. He held a leadership meeting at 6:30 that evening, and all the leaders got the word out to staff."

In a short time frame, staff moved quickly to prepare patients for transfer. "At about midnight, the chief medical officer and I went through every patient and determined whether they needed ACLS or BCLS, if so, how to transfer them in the safest possible way, and where they would be going," Mancher said. In the morning, she met with all nurse managers. "I gave them a form with each patient's name and receiving hospital, and how they were to be transferred. There was also an envelope that included medications, any allergies and all the nursing transfer instructions."

Patients were transported via private ambulances and city-provided buses, Mancher said. The hospital also received assistance from the New York City Fire Department. "They helped us with the transport and even came up to the units and helped us physically get the patients out," she said.

Patients were transferred to other Brooklyn facilities including Woodhull Medical Center, Long Island College Hospital, Maimonides Medical Center, Kingsbrook Jewish Medical Center, Interfaith Medical Center and Kings County Hospital, which received the majority of patients. Holliswood Hospital in Queens also received patients. During transfer, all critical-care patients were accompanied by either a nurse or resident and paramedics, Mancher said. ACLS patients were transferred one at a time, and patients who needed wheelchairs were transferred simultaneously.

To ensure continuity of care, Coney Island sent social workers and therapists with nursing staff to the receiving hospitals along with supplies to fully support its patients. "There were a few hospitals that needed our staff to stay around-the-clock," Mancher said.

The 24-hour deadline was no match for Coney Island's staff. The hospital successfully transferred the majority of its patients by 5 p.m., three hours before the deadline. Mancher credits Coney Island's dedicated and efficient staff. "No one said 'I have to go.' A lot of the nurses just said 'Just tell me where I need to go and I'm there," Mancher said. "I'm so proud of my staff."

Patients arrive

When they got word they would be receiving patients from Long Beach (N.Y.) Medical Center, staff at Nassau University Medical Center in East Meadow, N.Y., were ready. Having already been at a level 1 on the medical center's Hospital Incident Command System after the earthquake a couple of days before the hurricane, staff knew what to expect and how to prepare accordingly, said Linda Condon, RN, director of nursing, critical care. Both Condon and Laura Kyrillidis, RN, MHA, director of nursing, perinatal and pediatric services, were on duty when they were notified about the transferred patients.

"Laura and I and the other DONs then informed the nurse managers that we were getting patients from Long Beach," Condon said. Then the medical center implemented HICS, said Kathy Skarka, RN, MSN, CNA, NUMC's senior vice president and CNO. "The HICS notification was also spread through a pop-up screen on the computers that staff use for charting," she said.

About 56 patients were transferred to NUMC via ambulance or Able-Ride, a Metropolitan Transit Authority paratransit bus service for people with disabilities. Although patients arrived with about a four-day supply of medications, orders were entered into NUMC's system. "We decided to treat them all as regular transfers," Condon said. "We had our attendings enter orders as if these were our permanent patients. We then dispensed all new orders so it was a lot less confusing."

Because Long Beach was in a mandatory evacuation zone, many LBMC staff were able to stay at NUMC with their patients. "Some staff from LBMC had to evacuate their own homes. We also had volunteers [from NUMC] who were willing to step up and stay, so we used a combination of theirs and ours," Skarka said.

LBMC also sent additional lay staff to assist, which allowed staff to take time to rest and recharge. "We were able to have about 50 staff members at a time go and sleep," she said.

A. Holly Patterson Extended Care in Uniondale, N.Y., received about 28 residents from Long Beach Komanoff Nursing Home. Although it was short on much-needed staff, those who were there stepped up and put patients first, said Marie Magloire, RN, director of nursing. "We needed additional staff but were unable to secure them, so, therefore, we had to work more efficiently. Clinical administrative staff like me had to provide hands-on care, such as administering medications, changing diapers and feeding, while nonclinical administrative staff made beds, worked in the kitchen and monitored residents for safety, etc."

The mandatory evacuation order also forced NYU Langone Medical Center to evacuate patients to The Mount Sinai Medical Center. Staff immediately readied the hospital for 40 transfers. Mount Sinai initially received word of the evacuations from the Greater New York Hospital Association and then worked directly with NYU Langone staff, said Carol Porter, RN, DNP, CNO and senior vice president at Mount Sinai and associate dean of nursing research and education at the Mount Sinai School of Medicine.

NYU sent staff with 16 patients who were transferred to an interim step-down area that was set up in a Mount Sinai PACU, Porter said.

Michael McCarry, RN, senior vice president of perioperative services at Mount Sinai, helped set up that area because he realized the PACU was a perfect place for a step-down area. "In a situation like this it's not how many beds you have available, it's how many critical care beds can you create," McCarry said.

Similar to NUMC, calls from family members were handled with ease. "Family members were able to call into the unit and talk to the nurses," said Sonia Zabala RN, MPA, clinical director of cardiology services at Mount Sinai. "Friends and family members were able to visit."

NYU also sent two RNs to work in the NICU, while Mount Sinai provided staff for the remaining evacuated patients.

Mount Sinai and NYU Langone staff collaborated immediately, Zabala said. "One of the NYU nurses stated 'Mount Sinai nurses rock,' a compliment that was returned by the Mount Sinai nurses," Zabala said. "The camaraderie and bonding was instantaneous. You would think they had been working together for years."

Teamwork makes a difference

The morning of Aug. 29, facilities were actively transferring patients back or securing plans to do so. "Getting them out safely and in a timely fashion was much more important than getting them back quickly," Mancher said. The same methods were used to get patients back. A National Guard 18-wheel truck assisted with the transport of bed mattresses and equipment out of the A. Holly Patterson nursing home back to the Long Beach Komanoff nursing home.

In an emergency situation, teamwork is key to a successful outcome. "The staff and leadership at both NYU Langone and Mount Sinai were extremely collaborative and positive about the entire experience," Porter said. "This was an example of two Magnet nursing departments working together and maintaining their Magnet standards."


Tracey Boyd is a regional reporter. Send letters to editorNY@nurse.com or post a comment below.
New York City hurricane evacuation zones

Log on to www.NYC.gov/hurricanezones or call 311 to find out whether you live or work in a hurricane evacuation zone.

Zone A
Residents in Zone A face the highest risk of flooding from a hurricaneís storm surge. Zone A includes all low-lying coastal areas and other areas that could experience storm surge from any hurricane making landfall close to New York City.

Zone B
Residents in Zone B may experience storm surge flooding from a moderate (Category 2 and higher) hurricane.

Zone C
Residents in Zone C may experience storm surge flooding from a major (Category 3 or 4) hurricane making landfall just south of New York City. A major hurricane is unlikely in New York City, but not impossible.

No zone
Residents who do not live in a hurricane evacuation zone are unlikely to experience storm surge flooding from a hurricane.

Source: New York City Office of Emergency Management