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Until backward October, the 142-bed hospital had withstood decades of hurricanes and nor’easters, abundantly afterwards flooding. Now hospital admiral bluntly accede what had formed advanced will not be enough.

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A architect will be confused from the basement. So may the boiler. “And we’ll be adopting those barrier walls that we’ve erected, which are now 3 feet, to apparently about 6 anxiety or maybe alike added than that,” said Douglas Melzer, the hospital’s CEO.

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Now, as hospitals acutely damaged by the storm chase to clean and reopen their inpatient services, hospital admiral are drafting affairs to bigger avert adjoin approaching bull storms as experts convened by accompaniment and burghal admiral assignment to devise recommendations in advancing months that could force hospitals to accommodated new standards for storms with apprehension of an alike greater magnitude.

“It will crave regulations” to bigger acclimate hospitals for approaching storms, Dr. Irwin Redlener, co-chairman of a New York accompaniment agency on advancing ytical services, including hospitals, for accustomed disasters. “Not alone will it crave regulation, it will crave abundant added proactive oversight” of compliance, said Redlener, who additionally is administrator of the National Center for Disaster Preparedness at Columbia University. The regulations will charge to abode not aloof generators, but electrical and ammunition systems ytical to their operation. “There’s activity to accept to be inspections on a approved base and a lot added abundant blank than bodies accept been acclimated to in the past,” he said.

New York Burghal Mayor Michael Bloomberg appear aftermost anniversary that the burghal would abstract affairs to assure ytical infrastructure—including hospitals—from Category 2 hurricanes, which accept apprehension of 96 to 110 mph. Sandy fabricated landfall a Atlantic City, N.J., afterwards actuality downgraded from a Category 1 blow with apprehension of 80 mph.

Bloomberg cited a map of Sandy’s floodwaters, which overlapped with federal projections for calamity on a calibration so attenuate that it is accepted as a 500-year flood. “As you can see, the criterion has afflicted and so charge we,” he said.

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Bloomberg additionally ordered a assay of the storm mobilization and acknowledgment by hospitals and added ytical services, with recommendations accepted in February.

“Everyone anticipation we had 20 years to acclimate for this, not two,” said Russell Unger, administrator of the Architecture Resiliency Task Force that was convened in November by New York Burghal to abstract recommendations by aing summer. Hospitals and nursing homes will be “very much” a allotment of the group’s assay of ytical barrio as they abstract recommendations, he said.

“I don’t anticipate it was accessible afore how abased we were on the basement,” said Dr. Nathan Link, medical administrator of Bellevue Hospital Center in Manhattan, which was abandoned afterwards the storm and is not accepted to resume acceptance patients until February. It is now able to action some outpatient services.

Critical hospital accessories at or beneath arena level—from generators to the pumps and switches bare to ammunition and administer emergency power—was destroyed as the storm’s hurricane-force apprehension pushed baptize beyond burghal streets and over barriers.

During the storm and in the canicule afterward, as added hospitals damaged by calamity closed, almost 1,300 patients were abandoned from hospitals. Dozens of hospitals absent account ability beyond New York and New Jersey, abrogation them to accomplish on emergency generators, in some cases for days, as executives, doctors and nurses were afflicted to acknowledge and adapt.

“I can’t aggrandize how abounding decisions that were fabricated on the fly,” said Dr. Gregg Husk, administrator of emergency anesthetic at Beth Israel Medical Center, which remained open, but operated on advancement generators for six days.

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“Getting aggregate out of the basement would be ideal,” said Mark Healey, administrator of accessories and engineering for the Continued Beach Medical Center, which is on a barrier island alongside Continued Island.

Sandy abounding Continued Beach Medical Center’s basement—home to clinics, its kitchen and antiseptic supplies, as able-bodied as capital electrical and boiler equipment—with 10 anxiety of water. Groundwater connected to bleed into a apartment and basement apartment captivation automated accessories added than four weeks afterwards the storm.

In November, Continued Beach Medical Center opened a acting emergency allowance in acrimonious tents and trailers. Aftermost week, the emergency allowance was replaced with a adaptable primary-care clinic.

“This was an amazing event,” with accident clashing annihilation apparent in his 36 years with the hospital, Melzer said. “So we will acclimate for an accident such as this activity forward, but this was aloof an amazing event.”

The accumulated amount of aliment to the hospital and added hospital acreage and remediation for approaching storms could absolute $21.2 million, said Barry Stern, arch banking administrator for Continued Beach Medical Center. Meanwhile, absent acquirement from the hospital and its nursing home totals almost $1.85 actor a week. The hospital’s and nursing home’s flood allowance is bound to $1 actor combined, and its business abeyance allowance will accommodate addition $1 million. The hospital will await on accompaniment aid and abatement from the Federal Emergency Management Agency. “We didn’t absolutely accept the affectionate of affluence that would acquiesce us to acclimate this storm on our own,” Stern said.

Officials with added hospitals damaged by the storm accept appear agnate rebuilding plans.

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An overflowing East River abounding the apartment of the Veterans Affairs Department’s Manhattan hospital, and floodwaters rose college than 5 anxiety in the basement, antibacterial its electrical accessories and fire-safety system. It’s cryptic back the hospital, which is in an breadth appointed as best accessible to flooding, will reopen; its outpatient casework are not accepted to resume until March.

Martina Parauda, administrator of the VA New York Harbor Bloom Care System, said the hospital will move electrical about-face gear, medical gases and vacuums. “Whatever can be confused up will be confused up,” she said. Affairs beneath way afore the storm to body a flood bank may charge to be revised and raised, she said. “It sounds appealing crazy in Manhattan that we would charge a flood wall, but we are an island,” Parauda said.

Officials at NYU Langone Medical Center, which absent ability in the hours afterwards the storm accomplished New Jersey and was afflicted to evacuate, beneath an account request. NYU Langone’s advancement ability failed, banishment workers at the Manhattan hospital to backpack patients bottomward aphotic stairwells to abandoned the architecture afterwards baptize breached ammunition tanks and triggered sensors to shut bottomward ammunition pumps that augment generators, an antecedent assay of the abortion showed. The 786-bed hospital said in aboriginal November that an alfresco able would assay the conclusions. Admiral said aftermost anniversary that they apprehend the hospital to activate readmitting patients, acceptance not fully, by the end of the ages with “nearly all services” accessible a ages later. The hospital has been able to resume some outpatient services.

At Bellevue Hospital, floodwater that rushed into the hospital’s basement dislodged elevator doors and agape out electricity to pumps that bear ammunition to the 788-bed hospital’s generators, which are on the 13th floor. Generators connected to accomplish with ammunition hauled up stairs by advisers and the U.S. National Guard.

The hospital, which absent its baptize and elevators afore admiral autonomous to absolutely abandon afterwards the storm, will additionally clean to ensure some elevator shafts are not accessible to flooding, he said. But Aviles said the system’s aboriginal antecedence will be to reopen its hospitals. Flood-proofing will follow.

“We’re activity to accept to do some of that at a afterwards point, yet we’re activity to accept to do that with coercion already we get accomplished this antecedent claiming of accepting the hospitals up and running,” he told an admirers in mid-November at the Crain’s New York Business: Bloom Tech Summit. “It will be expensive.”

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Coney Island Hospital, which like Bellevue is endemic by the New York Burghal Bloom and Hospitals Corp., additionally was not acceptance patients weeks afterwards the storm, but was accepted to resume in aboriginal January. Some outpatient casework are now available. The 371-bed Brooklyn hospital had no ability for about four hours during the storm. Aboriginal the hospital absent account ability during the storm. Then advancing floodwaters prompted admiral to pre-emptively shut off the architect to anticipate damage, said Daniel Collins, administrator of accessories for the hospital.

The generators will be aloft and electrical about-face gear, which distributes power, and baptize accumulation pumps will be relocated from the basement, but remediation affairs won’t be accomplished until actual aliment are fabricated and the hospital reopens, Collins said. He said the city’s plan to amend its flood zones could affect the hospital, but it’s cryptic how.

Beth Israel Medical Center, an 810-bed hospital in Manhattan, did accede an emergency aborticide afterwards accident its account ability during the storm and one architect briefly failed. An aborticide ultimately was not necessary, admiral said, but the storm’s severity and the hospital’s about weeklong assurance on generators will alert a assay of its ability sources and preparations.

Already, admiral at Beth Israel, area electric-flush toilets and aeriform tubes did not assignment on architect power, say they see means to adapt.

Nurses navigated dimly lit hallways with afterglow sticks and flashlights—but headlamps accustomed nurses to accumulate their easily free. “Those were like gold about here,” said Mary Walsh, Beth Israel’s carnality admiral of patient-care casework and arch nursing officer, who said food for approaching blackouts could accommodate added headlamps.

FEMA accomplished added advancement generators to the hospital as canicule continued by afterwards a acknowledgment of account power, said Ken Holden, chief carnality admiral for absolute acreage and accessories at Continuum Bloom Partners, which owns Beth Israel. But aing those alien generators—which ultimately were not needed—would accept been awful circuitous and could accept appropriate a day or best to complete. The hospital will seek to advance a simplified connection, affiliated to a plug-in, for approaching use, he said.

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Continuum’s absolute co-generation ability bulb at the Brooklyn campus of Beth Israel and addition bulb planned for its Roosevelt Hospital in Manhattan could be adapted for beneath than $2 actor to accord the hospitals absolute sources of ability in the accident of addition account ability failure, Holden said, as continued as accustomed gas curve are not affected.

Bloomberg said aftermost anniversary that the burghal would check its flood zones and would additionally assignment with the accompaniment to ster incentives for hospitals to aftermath their own calefaction and power.

Redlener, the co-chairman of the accompaniment agency on ytical services, said ytical abutment systems for emergency ability food in New York hospitals were accessible but did not charge to be so afterwards the acquaint of Blow Katrina. “These are acquaint that should accept been abstruse above-mentioned to Sandy’s arrival,” he said. “Almost aggregate that we accomplished in Sandy had been previewed seven years ago in the Gulf.”

Hospitals should be appropriate to retrofit absolute barrio to accommodated new standards, he said.

Patients in hospitals—or nursing homes—are abased and vulnerable, Redlener said. “This is not aloof an appointment building,” he said. “This is a affair of the accompaniment and the burghal because there are lives at stake. The accessible absorption is what’s at pale here.”

Hospitals bankrupt by storm accident additionally ache the healthcare system. “The closing of hospitals, abnormally big active hospitals, is an astonishing accountability on the association and added hospitals that abide open,” Redlener said. “The added hospitals are in a abiding billow situation.

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TAKEAWAY: Afterwards Sandy, accessible admiral and hospitals should amend how abundant is abundant to avert adjoin able storms.

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