Preparedness and Response to Hurricane Sandy

National Planning Frameworks define five mission areas that require preparedness in
order to enhance the nation’s security and resilience with regards to both man-made and
natural disasters (Homeland Security, 2014). The five mission areas are prevention,
protection, mitigation, response and recovery. This paper analyzes how two of these mission
areas – preparedness and response – were implemented during Hurricane Sandy and how state
and federal public health laws interacted during the implementation of these two mission
areas.

Preparedness and Response Mission Areas

Preparedness includes all activities that are taken to increase the ability of a
community to effectively respond to a disaster. These activities include planning, evaluating,
training, organizing, and exercising (Homeland Security, 2014). The goal of preparedness is
to ensure that the community has effective coordination when responding to an incident.
There are many forms that preparedness measures take. They include establishment of back-
up of lifeline services, such as water and power, rehearsing of various evacuation plans, and
construction of temporary shelters to house people who get displaced by the floods
(Homeland Security, 2014).
In terms of health, preparedness includes evacuation plans for hospitals in case the
disaster incident becomes serious enough to cause significant disruptions to activities of
healthcare facilities (Homeland Security, 2014). It also includes stockpiling of important
medical supplies such as medicine to ensure continued care of already sick patients and care
of people who might get injured or get sick during the disaster incident.
Unlike preparedness which includes activities that improve the ability of a community
to respond to disaster incidents, response includes actions that are taken immediately before,

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during, and after the disaster. The goal of response actions is to minimize loss of life and
property and alleviate the suffering of people as a result of the effects of the disaster
(Homeland Security, 2014). In regard to healthcare, response actions include evacuation of
patients from facilities that are threatened or damaged by the disaster to safer facilities.
Implementation of Preparedness and Response During Hurricane Sandy
Hurricane Sandy formed in the Caribbean in late October, 2012 and hit the east coast
of the United States on October 29 (Toner et al., 2017). The hardest hit states were New
Jersey and New York. In both states, the hurricane caused massive loss of life and property.
By the time the storm ended, it had caused killed 117 people and left around 4,000 others
injured (Toner et al., 2017). It also caused extensive destruction of roads, bridges, buildings,
and other forms of physical infrastructure in addition to destruction of many homes. The
destruction of homes led to displacement of thousands of people that required to be provided
with temporary shelter. In terms of cost, the hurricane led to destruction of property worth
around $68 billion thus making it the second costliest disaster in the USA after 2005’s
Hurricane Katrina (Toner et al., 2017).
Healthcare facilities were not spared destruction during Hurricane Sandy just as it had
been the case during Hurricane Katrina. Before Hurricane Katrina, it was thought that
hospitals could provide a refuge for people escaping catastrophic events. However, the full
and partial destruction of many healthcare facilities during Hurricane Katrina forced the
federal and state governments to put in place plans to ensure safety of staff and patients as
well as continued care of patients. As part of these plans, various laws were enacted to protect
healthcare facilities or to provide guidance of appropriate action to be taken when disasters
impair or threaten the ability of healthcare facilities to provide essential medical services to
those who need them.

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Public health preparedness
The federal government has policies that guide how hospitals should prepare and
respond to disasters. For instance, the federal government requires hospitals to develop and
implement an emergency plan to be put in action during disaster situations. The policies also
require hospitals to maintain a physical environment that guarantees the safety and well-being
of patients (Levinson, 2014). This requirement touches on areas such as emergency lighting
and power for emergency rooms, intensive care, and patient recovery facilities.
Federal laws also require hospitals to meet Life Safety Code provisions. One of these
provisions is establishment of a plan for evacuating patients if it becomes clear that a given
disaster incident threatens the safety of patients in the hospital or impairs the ability of the
hospital to continue providing them the care that they need (Levinson, 2014). Another
requirement of Life Safety Code is that hospitals that have emergency departments enough
nursing and medical staff who are qualified to provide patients with emergency needs
(Levinson, 2014). Therefore, the federal laws were directed at hospitals and were meant to
ensure that hospitals were effectively prepared to maintain the safety and well-being of
patients during emergency situations.
Hurricane Sandy primarily affected four states in the Mid-Atlantic region. These
states are New Jersey, New York, Maryland, and Delaware (Levinson, 2014). Like the
federal government, these states have laws that are meant to promote public health during
emergency situations. However, unlike the federal laws which guide hospitals on how to
prepare for disaster situations, the laws of these states are mainly concerned with actions to
be taken when hospitals fail to observe federal laws regarding safety and wellbeing of
patients during emergency situations. For instance, laws of these states give governors
powers to order evacuations of hospitals when they fail to do the evacuations on their own

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(McGinty et al., 2016). Thus, state laws complement federal laws with regard to public health
preparation for emergency situations.
Public health response
When faced with disasters, such as hurricanes, many hospitals are usually uncertain
on the appropriate steps to take to protect their patients and staff. Given the uncertainty of
storm forecasts, actions that hospitals take can turn out to be either too drastic and, therefore,
unnecessary if the storm arrives when it is already weak or makes a turn to another place, or
too mild as to put many patients at risk if the storm arrives when extremely strong (Powell,
Hanfling & Gostin, 2012). Even though it is an important public health action during
emergency situations, none of the states that were heavily affected by Hurricane Sandy has
any laws governing shelter-in-place (McGinty et al., 2016). Shelter-in-place orders require
people to take refuge wherever they are in order to be safe during emergency situations.
Unlike shelter-in-place orders, all the four states that were affected by Hurricane Sandy
provide governors with powers to order evacuation of hospitals during emergency situations
in line with the requirements of federal laws (McGinty et al., 2016). However, none of the
governors issued evacuation orders for hospitals during the hurricane.
The absence of orders does not mean that no hospital evacuated. 93% of the hospitals
in the four states sheltered in place while 7% either evacuated fully or partially (Levinson,
2014). The decision of hospitals to shelter-in-place, partially evacuate or fully evacuate
depended on a number of factors. They include concerns about the structural integrity of the
hospitals and the location of the hospital. Most of the hospitals that evacuated were located in
flood zones (Levinson, 2014). Thus, many hospitals responded to Hurricane Sandy following
guidelines of federal laws governing public health during emergency situations.

Conclusion

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Hurricane Sandy was one of the most destructive superstorms of recent times. The
hurricane led to deaths of many people and destruction of property worth tens of billions of
dollars. Like other storms, Hurricane Sandy also constituted a serious threat to public health
as it led to destruction of hospitals. However, thanks to federal and state laws governing
preparation and response of hospitals to emergency situations, the hospitals responded in an
appropriate manner and prevented patient deaths.

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References

Homeland Security (2014). Overview of the National Planning Frameworks.
Levinson, D. (2014). Hospital Emergency Preparedness and Response During Super Storm
Sandy. Office of Inspector General
McGinty, M. D., Burke, T. A., Resnick, B. A., Smith, K. C., Barnett, D. J., & Rutkow, L.
(2016). Legal preparedness for Hurricane Sandy: authority to order hospital
evacuation or shelter-in-place in the Mid-Atlantic region. Health security, 14(2), 78-
85.
Powell, T., Hanfling, D., & Gostin, L. O. (2012). Emergency preparedness and public health:
the lessons of Hurricane Sandy. Jama, 308(24), 2569-2570.
Toner, E. S., McGinty, M., Schoch-Spana, M., Rose, D. A., Watson, M., Echols, E., &
Carbone, E. G. (2017). A community checklist for health sector resilience informed
by Hurricane Sandy. Health security, 15(1), 53-69.