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Organizing Chaos: Hospital Evacuation During Hurricane Sandy

By Amesh A. Adalja, MD, FACP, FACEP, February 7, 2014

Abstract: From October 22 to 31, 2012, Hurricane Sandy affected 14 US states and Washington, DC, causing particularly severe damage in New York and New Jersey. It was the second costliest hurricane in US history and caused 43 deaths in New York City and tens of thousands of injuries. When Sandy hit New York City on October 29, 2012, the flooding and power outages led to the evacuation of residents, hospitals, nursing homes, and assisted living facilities. New York City hospitals and various government agencies evacuated approximately 6,300 patients from 37 healthcare facilities. . . . Despite robust preparedness efforts, the severity of Sandy caught New York City hospitals by surprise because major hospital evacuations were not anticipated. Widespread power outages forced hospitals to rely on backup generators, which subsequently failed because of flooding. When healthcare facilities evacuated, neighboring institutions received the displaced patients.1

The above abstract summarizes a recently published study that my Center colleagues and I conducted to describe the effect of hospital evacuations on hospitals in New York City.

Sandy made landfall in October 2012, prompting evacuations of thousands of individuals from healthcare facilities. Some facilities in flood prone areas pre-evacuated, but 2 hospitals (Bellevue and NYU Langone) evacuated in the midst of the storm. We sought to understand how the evacuations that occurred during the storm affected the hospitals that took in displaced patients. We also examined how the months-long closure of these 2 facilities affected patient surge in Manhattan hospitals.

Notable findings include the following:

  • Hospital emergency managers viewed themselves as part of a coalition and acted accordingly (ie, they turned to one another for help).
  • Moving complex patients at tertiary centers required a lot of communication among physicians adept at managing those patients—such cases were not just simple transport decisions.
  • Utilizing out-of-state ambulances (as was done when FEMA-contracted ambulances were brought in) posed logistical problems because of unfamiliarity with the city and its hospitals.
  • Planning for special populations is crucial (eg, patients on dialysis, patients on methadone), as they presented to EDs after the storm in large numbers.
  • Sustained surge required hospitals to remove slack in the system and convert open space into patient care areas.
  • Credentialing of displaced physicians was challenging, but feasible.
  • Pre-evacuation is much less daunting a task than real-time evacuation.
  • Hurricane Irene, during which pre-evacuation was considered an over-response, conditioned the response to Sandy.

Optimizing Evacuation

As hospital evacuation is a core component of hospital emergency preparedness and leverages the power of healthcare coalitions, we hope this study will help inform how hospitals nationwide plan for evacuations and other catastrophic health events in the future. By learning from the experience of Sandy, a path may be cleared to making an unavoidably chaotic process a little smoother.


Adalja AA, Watson M, Bouri N, Minton K, Morhard RC, Toner ES. Absorbing citywide patient surge during Hurricane Sandy: a case study in accommodating multiple hospital evacuations. Ann Emerg Med 2014;