Put to the Test: Hurricane Irene


Hurricane Irene
Photo from NASA.gov

For the next four years, LIJ thankfully faced no major natural or manmade disasters. But late on Saturday, August 20, 2011, Tropical Storm Irene formed over the Atlantic Ocean 120 miles east of the Caribbean. On Wednesday, August 24, weather forecasts indicated a high probability that Irene—then a Category 3 hurricane just north of Haiti—would hit the New York metropolitan area. North Shore-LIJ activated its Emergency Operations Center in Syosset, NY and began preparing for the storm.

Solazzo, Romagnoli, Mahoney and the other members of North Shore-LIJ's Incident Command team prepared for the possibility of evacuating one or more hospitals. They alerted the system's employees to prepare for the hurricane and initiated a rapid discharge throughout the system to open as many beds as possible. They canceled all elective procedures. They reviewed evacuation plans for Southside Hospital and the two Staten Island University Hospitals. "It was really tense," recalls Romagnoli.

We had never evacuated before. As the storm gets closer and the track continues to hold and the winds continue to be sustained at hurricane force, we are coming quickly to the realization that we have to evacuate.

Mandatory. On Thursday, August 25, the City of New York ordered that low-lying coastal areas—Flood Zone A—be evacuated by 8 p.m. on August 27. [18] The order was mandatory. The city determined flood zones using the federal government's Sea, Lake and Overland Surge from Hurricanes (SLOSH) Model. A storm surge was a temporary rise in sea level caused by a storm's winds. The wider the storm and the stronger the winds, the higher the storm surge. Coastal geography also played an important role. Storm surges that hit the New York metropolitan area were boosted in size and speed by the natural funnel formed by northern New Jersey and Long Island. Zone A marked areas at risk of flooding from the surge of a Category One hurricane. [19]

North Shore-LIJ's Staten Island hospitals were in Zone A. Because of the logistical challenges of evacuating hospitals on short notice, the city had no choice but to give healthcare facilities the option—unavailable to other individuals or businesses—to shelter in place. Romagnoli, as chief of protective services, recommended that LIJ evacuate those hospitals. That night, as EVP/COO Solazzo weighed his decision, the three vulnerable North Shore-LIJ hospitals moved to the next stage of the evacuation process and began moving mechanically dependent patients, including those on ventilators.

The Incident Command team determined that Staten Island University North was the hospital most vulnerable to the storm surge, predicted to be five feet. They made the assessment that if the surge went that high, the hospital was right at the line of being able to maintain generator power. However, floodwater knocking out backup power wasn't the only risk Irene posed. "You’ve got to understand all the threats to your institution," says Solazzo.

Staten Island University Hospital - North Site
Image courtesy of North-Shore LIJ

There was a significant chance that Irene's storm surge would breach Staten Island's sewage treatment facility. If that happened, sewage could be forced back into the hospitals. "We tried to get from our engineers and from the city engineers their best estimate, and it became basically a 50-50 shot," says Solazzo. "I was not comfortable riding out a 50-50 and not having any backup plan if that happened." The team considered vertical evacuations within the Staten Island facilities, but in the end determined that the risk was too great and a full evacuation was warranted. "So we pulled the trigger on Staten Island at that point," says Solazzo. "That was a little over 48 hours to the storm."

The decision. It was the first time hospitals in the region were evacuated in advance of a hurricane. It was a decision "none of us thought we would make," says Romagnoli.

It’s hundreds of people. And I have to tell you, it’s tough. The thing that makes it hard is you have to make [the decision] so far out. You have to make it while you leave yourself a nice window of time that you can complete the evacuation prior to the storm.

Confirms Solazzo: "It’s probably one of the most significant, most difficult decisions I’ve made in my career. After you make the decision, you’re holding your breath."

North Shore-LIJ's two Staten Island hospitals were evacuated the next day: Friday, August 26. It was a sunny day. Patients were brought to a staging area at each hospital. An official checked each patient's identification wristband to confirm that the patient was going to the right facility in the right type of vehicle. Each hospital maintained a list of evacuees and periodically sent the list to the Emergency Operations Center. The patients were moved on ambulances and buses. A few were moved by helicopter. [20] That afternoon, the city expanded the evacuation order to include portions of the Rockaways in Zone B, and moved the deadline to 5 p.m. on the 27th. [21]

Click here to see a map of the three hospitals in relation to the evacuation zones.

The North Shore-LIJ Incident Command team weighed their options for the third vulnerable facility, Southside Hospital, on the evening of the 26th. It appeared that the storm surge was not likely to reach the hospital from the shore, however, a creek flowed behind the facility and some of the company's engineers were concerned that it could channel the storm surge into the hospital. Solazzo determined the risk was sufficient to warrant evacuating the hospital. They began a phased evacuation that evening and completed it by the middle of the next day. In all, North Shore-LIJ evacuated 947 patients from three at-risk hospitals long before Irene's winds lashed the buildings. Despite the evacuations, the three hospitals remained open with sufficient staff to treat emergency cases. "You can’t have a closed sign on the door," says Romagnoli.

North Shore-LIJ's evacuation plan worked smoothly. It also turned out to be unnecessary. At 5:35 a.m. on Sunday, August 28, 2011, Irene made landfall near Atlantic City, New Jersey. Irene weakened shortly before hitting the shore, losing some of her punch. Winds dropped from 86 to 69 miles per hour. The storm's rainfall produced devastating floods in Vermont and upstate New York, but Irene's winds and 4-foot storm surge brought relatively little damage to the coast.


[18] New makes it hard is you have to make [the decision] so far out. You have to York City press release PR-308-11. See: http://www.nyc.gov/html/om/html/2011b/pr308-11_alt.html

[19] New York City Natural Hazard Mitigation Plan, Coastal Storms: Multi-Hazard Analysis for New York City. See: http://www.nyc.gov/html/oem/downloads/pdf/hazard_mitigation/section_3f_coastal_storm_hazard_analysis.pdf

[20] “A Hospital System's Response To A Hurricane Offers Lessons, Including The Need For Mandatory Interfacility Drills,” Health Affairs , 31, no.8 (2012):1814-1821

[21] New York City press release PR-308-11. See: http://www.nyc.gov/html/om/html/2011b/pr308-11_alt.html