By all accounts, clinicians rose to the occasion when Superstorm Sandy hit, whether in the now-famous scenes of manually pumping air in NICU babies while descending flights of stairs or managing the influx of patients in the ED in need of dialysis or just some warmth.
The medical soap opera aspect of the superstorm is slowing down this week but much work remains in moving out of disaster recovery mode for the affected communities.
As power is slowly returning to residents of New York and New Jersey, patient census at area EDs is tapering off. However, the outlook is murky at best. Though more residents are back on the power grid, the gas shortage threatens to reduce clinicians' ability to drive to the hospitals. Furthermore, a nor'easter is forecast in the already ravaged region later this week.
During and immediately after the superstorm, predictions for a patient surge in the ED were on the mark.
At Princeton University Medical Center in Plainsboro, NJ, the ED opened its doors to 170 individuals on Oct. 31. Normal volume ranges from 115-125 patients, said Susan Lorenz, DNP, RN, chief nursing officer. Though the number of ED visitors is dropping, Lorenz expressed concern for the area's predominantly elderly residents, many of whom are still without power or missing critical doctor's appointments.
"Our biggest issue is the unprecedented number of patients," she confirmed. "Some of these patients are very old and very sick. We're also dealing with people who may have had doctor's appointments to get medication changed that were cancelled due to the storm."
As electricity remains off for some, Lorenz said the elderly and those with weakened immune systems are becoming increasingly more susceptible to the flu and pneumonia.
In neighboring New York, Terri Lyman, spokesman for North Shore-Long Island Jewish Health System, verified that EDs are especially busy at the community hospital level and all facilities are at capacity.
Though North Shore-LIJ discharged as many patients as possible in the days leading up to the storm, they've also accepted 94 patients evacuated from New York University Langone Medical Center, with most going to Lenox Hill Hospital in Manhattan and others dispersed between Forest Hills Hospital and North Shore University Hospital. Some of these patients are ventilator-dependent or have traumatic brain injuries, said Lyman. Additionally, 78 patients from nursing homes in the Rockaways were placed at North Shore-LIJ facilities.
"We expected other hospitals to have problems if the storm turned out to be as bad as predicted and we tried to free up as many beds as possible beforehand, said Lyman.
Lyman classified the patient census as "at capacity but under control." The ED is busy, but volume is slowing. Like at Princeton University Medical Center, the days without power are taking a toll on area residents.
"People are feeling the effects of having no power for six days," Lyman said. "Older people and younger children are particularly vulnerable. We're starting to see some hypothermia from people who stayed in their homes as well as random carbon monoxide poisoning from generators running too close to windows."
The story is the same at Meridian Health System. Rich Hader, RN, THD, senior vice president of nursing, classified his system's EDs as "just swamped." In the days immediately following the storm, much effort went into collaborating with Red Cross and OEA to get oxygen and medications to patients while pharmacies were closed.
While the medication shortage is lessening as pharmacy chains open, the gas shortage has persisted despite politicians' promises. Last weekend, the state of New Jersey implemented a rationing plan but lines at the pump are as long as ever.
"Nobody wants to be in a situation where a hospital can't care for patients because employees don't have gas to get to work," said Lorenz, echoing every administrator's worst fear.
Princeton University Health System is working with area gas stations to inform employees of exact times when the stations are open and equipped with fuel. North Shore University-LIJ established an online carpool resource and is in the process of setting up busing for staff from its emergency resource centers.
"The challenge here is communication," said Lyman. "We've published the information on Facebook, through email and our telephone system, but, without power, most are still learning about these resources through word of mouth."
Despite the patient surge and maddening gas shortage, the frontline staff's dedication has been the silver lining in Superstorm Sandy.
Hospitals were able to support the influx of patients, in large part, because staff turnout has been extremely high. Despite the fact that many clinicians' own homes have been destroyed, most are still reporting to work.
North Shore University-LIJ went into the superstorm with 150 percent staffing levels. Currently, 400 employees have been displaced and the health system is connecting them with temporary housing.
Staff levels have not been a problem at Princeton University Medical Center either. One reason can be attributed to Lorenz's personal mantra that the most important part of emergency management planning is creating a contingency plan for your own family. Setting an example for her staff, she personally drove her own children two hours west to their grandmother's so she could focus on providing healthcare to the residents of Plainsboro.
"You really have to think about planning for your own family situation beforehand to meet the obligations of our profession," she said.
Robin Hocevar is senior regional editor at ADVANCE.