In the aftermath of Hurricane Katrina, North Shore-LIJ sent Mary Mahoney, director of Emergency Planning and Preparedness, to New Orleans to learn as much as possible about what happened at Memorial Medical Center and the other affected hospitals. "Katrina changed the way we think," says Romagnoli.

When we saw patients left behind, when we saw that healthcare was now not being delivered for New Orleans... we said, 'That cant happen to us. Absolutely, positively, we cannot let that happen to us. So what are we going to do about that? Is our evacuation plan good enough?' We took out our plans and we reviewed them and we tweaked them.

North Shore-LIJ officials were confident that their evacuation plan was effective. They tested it by running a drill at Southside Hospital in Bay Shore on Long Island. Southside was particularly vulnerable to storm surge flooding, and Romagnoli knew that it was likely to need evacuation if a major storm hit the area. On Sunday, November 20, 2005, with hundreds of Boy Scouts and Girl Scouts standing in for patients, North Shore-LIJ carried out its evacuation plan. To Romagnoli's dismay, it failed badly. They didn't get everybody out:

My great plan didnt work. We were shocked. We thought the plan was solid. And I think anybody who looked at that plan would have thought it was solid. But the fact of the matter is, when push came to shove and we really had to move bodies, words did not translate into actions. We started at 9 a.m. By 12, we had hoped to move about 100 patients. We had moved four. We had hundreds of [transportation] resources waiting in the parking lot, and patients never made it to them. It was a logjam. We had people stacked up in the hallways. ^[16]

The Southside drill showed that established practices for moving patients broke down when time was short and the number of patients large. The practice of individually matching evacuees to available beds in other hospitals simply took too long. Transporting patients one by one was also impractical.

Romagnoli and his team went back to the drawing board and devised an evacuation procedure that centered on moving groups of patients at a time. Hospitals were designated to receive specific types of patients, and those patients were transported as groups. Tertiary hospitals received critical care patients, and community hospitals received general medical and surgical patients. The designations made it easier for receiving hospitals to prepare beds, supplies and staff for the new patients. Evacuating hospitals moved groups of patients concurrently. Previously, patients were evacuated according to a priority list, which meant a delay in moving one patient held up everyone else in the queue. ^[17]

On Sunday, July 22, 2007, after months of training and tabletop exercises, North Shore-LIJ repeated the evacuation drill, and this time all of the faux patients were evacuated successfully. "It worked like a charm," says Romagnoli. North Shore-LIJ learned significant lessons in those drills, says Solazzo. "What we learned was we have to batch evacuate We know we have 10 beds at LIJ [Long Island Jewish Medical Center] that are ICU beds. Ten patients are moved from Southside to those 10 beds."

Mark Solazzo discusses lessons learned from the evacuation drill: