Introduction

On Friday, October 26, 2012, a massive storm named Sandy was bearing down on New York City. Municipal authorities up and down the eastern seaboard debated whether to evacuate communities, close public offices or halt public transport. The storm had reached hurricane strength and had already devastated the Caribbean.

Few entities had more at stake in a storm of this magnitude than hospitals. Moving patients out was costly, labor intensive, physically hard on the patients and a logistical nightmare. But leaving patients in a hospital in a storm’s path risked the loss of heat and electricity, direct hits on roofs and buildings, stranded medical personnel or impassable roads, resulting in the threat of substandard care—even death—for the ailing.

James Romagnoli was hospital safety executive for the nonprofit North Shore-Long Island Jewish Health System (North Shore-LIJ). The network owned 15 hospitals on Long Island and in New York City. Three of them—Staten Island University Hospitals North and South, and Southside—sat in low-lying areas and were at risk of flooding in severe storms. Romagnoli, who brought broad experience in emergency preparedness and crisis management to the hospital system when he joined in 2001, had built an emergency operations center, taught crisis decision-making skills to physicians and other employees, and instituted emergency management best practices.

At the last minute, however, Irene had altered course and greater New York escaped essentially unscathed. [1] North Shore-LIJ had effectively put its patients through an arduous evacuation exercise needlessly. There were no specific negative consequences, but the experience reinforced for hospital planners the pros and cons of evacuations, and the challenges of planning for weather-related events.Just 14 months earlier, Romagnoli and North Shore-LIJ had put this infrastructure to the test when Hurricane Irene bore down on the East Coast. In August 2011, forecasters and public officials alike warned that Irene would wreak havoc on coastal communities. New York City, among other municipal authorities, evacuated low-lying areas. Romagnoli and his team decided to evacuate the three threatened hospitals, and on August 24, 2011, 947 patients moved to other facilities further inland.

All this weighed on the minds of Romagnoli and COO Mark Solazzo as Hurricane Sandy approached. The storm was expected to make landfall on October 29, 2013. But for safety reasons, an effective evacuation had to be completed more than 48 hours in advance of landfall. The National Weather Service and the company’s private weather consultants both painted a grim picture of the storm’s strength. However, that was the prognosis before Irene as well. Romagnoli and Solazzo had only a few hours to decide whether to order an evacuation of the three at-risk hospitals, as they had with Irene, or allow patients to remain in place, with the attendant risks.


[1] Vermont ultimately bore the brunt of what was still a terrible storm.