Improving Emergency Plans and Procedures in the Aftermath of Hurricane Sandy

Professor Sumner

Public Health Preparedness II

Kara Ramos

20 April 2016

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In October 2012, the northeastern part of the United States faced devastating winds and

rain that took the lives of many. The storm named Hurricane Sandy called upon friends,

neighbors, first responders, and the government to come together and help each other. Despite

the government’s attempts to aid the people, nothing could have prevented this from occurring.

However, their lack of preparedness put the lives of many at stake. In response to the storm, the

federal government spent more than $60 billion in emergency spending and this was partly

because of the several declarations FEMA passed over 20 years which took money out of the

Disaster Relief Fund (Bucci, et al., 2013). This was one of the many factors that contributed to

the unorganized efforts by the government, public health officials, and the community. Besides

FEMA’s role during and after the storm, we must also look at the role and responsibility of the

state's, community, and the National and Coast Guard. Finally, it is also important to look at

vulnerable populations of which are often overlooked. These issues show the areas that our

country should strengthen and improve. The underlying problems that each of these issues have

are the lack of communication and coordination between all levels of government and the

community. Despite improvements from previous disasters such as Hurricane Katrina, the

mistakes of Hurricane Sandy could have been avoided with proper planning and better decision

making. The issues of this disaster depict the importance of implementing programs and

procedures in preparation for major disasters such as this event.

To understand where America went wrong amidst the disaster of Hurricane Sandy, we

must look at the planning and communication process in hospitals, the role and responsibilities

of FEMA, the National Guard, as well as the states. Finally, it is necessary to look at the

coordination and communication barrier between public health officials and the at-risk

population. Hurricane Sandy was presented with many failures including electricity in hospitals.

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This made it difficult for medical staff to properly care for their patients. In the article,

“Hurricane Sandy: Lessons Learned, Again”, authors David M. Abramson and Irwin Redlener

talk about the shortage of medical staff such as doctors and nurses, and the problems they faced.

For instance, in a Bronx gym, hospital staff volunteered to help disabled individuals from adult

homes who came with no medical records. In addition, the staff in a Manhattan hospital had to

carry patients down flights of stairs that were dimly lit because the generators failed. In reality,

however, there was a lack of preparedness that existed in all these situations during Sandy and

could have been avoided with planning beforehand (Abramson & Redlener, 2012). These authors

argue that the public’s response to issues such as evacuation of residents where the storm would

greatly affect, could have been acted upon in a timely matter. In this case, it is important to

communicate to at-risk populations that may be affected, before, during and after the event

(Abramson & Redlener, 2012).Over the past 10 years, public health emergency preparedness,

has without a doubt, made important contributions and changes in “command and

communication, assuring appropriate and rapid supply chains, and training the medical and

public health workforces to respond appropriately” (Abramson & Redlener, 2012). Despite this,

medical and public health officials failed to provide sufficient aid to certain areas like the

Rockaways, Coney Island, Staten Island and New Jersey, after the storm. Much of this had to do

with the lack of organization, coordination, and communication among all levels. Public health

systems should learn, again, the importance of coordinated structures especially in crises. Also,

they should make sure that there resources, in case of an emergency, like fuel for generators or

having electronic medical records, should always be available (Abramson & Redlener, 2012). It

is important that hospitals have plans, procedures, and extra resources in place in the event of a

storm so they can tend to the needs of their patients. In the Journal of the American Medical

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Association, Tia Powell, Dan Hanfling, and Lawrence Gostin explain the failures of healthcare

institutions to provide the necessary care to injured patients because they did not have the

capacity to care for large influx of patients (Powell, Hanfling, Gostin, 2012). For instance, many

New York Hospitals had better emergency plans and access to more resources like back up

generators. However, there was still much to be assessed and the whole evacuation process could

have been more organized. In this case, there should have been better rules and guidelines for the

evacuation process (Powell, Hanfling, Gostin, 2012). Even after Hurricane Sandy, hospitals

found it difficult to perform certain operations and provide patient care to a number of people.

This poses a health problems due to the limited access to healthcare, puts pressure on health care

systems who have lost many patients because they could not accommodate for everyone’s needs,

and creates financial problems (Powell, Hanfling, Gostin, 2012). There are a variety of issues

that federal, state, and local officials must focus on especially collaboration and communication

during catastrophic events. This gives public health officials the responsibility to work alongside

organizations to decided whether or not transferring patients, for instance, is necessary when

there is not enough room for them in the hospital (Powell, Hanfling, Gostin, 2012). It is the

responsibility of the government and healthcare authorities to work in unison with other

organizations to make this happen and it is their responsibility to make sure they have rules and

equipment in place for future events.

Another issue was FEMA’s lack of cooperation during Hurricane Sandy that made

recovery difficult. In a report by The Heritage Foundation Emergency Preparedness Working

Group, a list of lessons from Hurricane Sandy were summarized in which it recommended that

FEMA should not focus on every disaster especially routine disasters to ensure that they have

enough resources and money to aid the affected areas in a more efficient and timely matter. To

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add, both the National and Coast Guard should maintain organization of roles and resources as it

did during the storm for future storms. Finally, states should be given the authority to respond

and help the community (Bucci, et al., 2013). These recommendations suggest the lack of

planning and preparing that went on before,during, and after the event. The aftermath of

Hurricane Sandy highlighted FEMA’s lack of aid to affected areas. As stated previously, the

federal government spent more that $60 billion dollars for emergency cases like this because

money was taken out of the Disaster Relief Fund multiple times for other disasters (Bucci, et al.,

2013). Over the past 20 years, declarations have been made to address the multiple disasters-

disasters both catastrophic and not catastrophic- so it should have been no surprise that the DRF

had little money to provide financial aid to the affected areas and states on the east coast. The

obvious solution would have been for FEMA to save the money in the DRF so that when bigger,

more catastrophic disasters did occur, they could use it to provide resources to the community. In

addition, saving would mean the federal government would not have to turn to emergency

spending as much. The authors also suggest that there should be clear standards to define which

disasters or situations qualify for emergency spending (Bucci, et al., 2013). However, despite

FEMA’s passive role in the storm, it has certainly improved from previous events like Hurricane

Katrina. One aspect is their use of social media during the storm to make sure communities were

updated as frequently as possible. In an article called “Sandy Marked a Shift for Social Media

Use in Disasters”, author Sara Estes Cohen explains the positive impact of social media during

Sandy and FEMA’s cooperation in it. Throughout the storm, FEMA constantly used social media

where they informed people in the community about news regarding the storm and also shared

information before the storm to keep them prepared. They also made sure they knew what was

going on in the affected areas by looking at messages posted on social media platforms such as

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Twitter and Facebook (Cohen, 2013). FEMA made it possible to communicate with others and

successfully spread important information to the public. Its role in Hurricane Sandy is both a

lesson to be learned but it also shows their coordinated effort in communicating with the affected

communities which should be seen in future disasters.

It is also important to give responsibility to the states because this allows them to

respond and recover from the disaster directly and it would relieve the burden FEMA has. This

would allow FEMA more time to prepare and take precautionary measures rather than to only

respond to the situation when it occurs. For many years, FEMA has spent money on less

devastating events where places were left without assistance for many days- Staten Island being

one of them (Bucci, et al., 2013). For the most part, it is evident that the storm would have been

less of a “disaster” if FEMA would do its job by focusing much of its attention to catastrophic

events that impact the community on a greater level. State and community cooperation is

necessary to keep everything running smoothly and efficiently.

Despite the disorganization during and after the disaster, both the Coast Guard and

National Guard worked successfully up to the recovery phase. After learning from the failures of

Hurricane Katrina, “dual-status commanders” were implemented and trained to “reduce

redundancies”(Bucci, et al., 2013). To this effect, they qualified as both state and federal

authority and this structure allowed both state and federal commanders to get instructions from

the same workforce and allowed them to work in a timely and efficient manner. In this way,

60,000 national guardsmen were on alert and ready to help if they were needed and even though

not all guardsmen were used, it shows their preparedness efforts in dealing with the crisis. Their

role was search and rescue, providing food and water, clearing debris and roads, controlling

traffic and more ( Bucci, et al., 2013). The same was true for the Coast Guard and the number of

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important roles they played during and after Sandy like search and rescue. While the efforts of

both the National and Coast Guard were successful during Sandy, it is important to continue to

learn from the mistakes of Sandy in order to ensure success for future events, adopt and accept

the “dual-status commander” role that was created during the storm. Another important change

that needs to take place is that Congress should update the Coast Guard fleet in order to meet the

needs of a greater number of people (Bucci, et al., 2013). The role of the National and Coast

Guard portray the importance of implementing and maintaining the structure and status held by

these commanding forces.

Another major issue that needed to be addressed during and after the storm, was the need

to aid the vulnerable populations. Hurricane Sandy exposed the problems that lay in basic

foundations of public health efforts. This can be seen in many organizations who do not

communicate effectively with other organizations or groups, and the populations and areas that

are isolated and are a possible target to these natural disasters. It is important to include the

community in planning and response efforts and in order to do this, communication is key in

bridging the gap between the community and health professionals and officials. First responders,

for instance, were not able to help individuals that were not able to survive on their own without

the proper equipment, resources, and aid. Health care professionals and first responders should

be able to address the needs of disabled individuals (both mentally and physically), the elderly,

children, and those who do not speak English, without having to worry about the groups of

individuals who have the ability to take care of themselves (Bucci, et al., 2013). As a result, there

would be higher resilience but this only works if the community is prepared and has the proper

tools to help themselves and eventually, they will be able to help the rest of the community. The

change rests not only in governmental control but in the community’s responsibility to help each

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other. The New York City Housing Authority is just one example of the lack of authority that

went on during the storm that affected many disabled and elderly people. Other agencies in the

city along with NYCHA already had a list of people who needed assistance but no one bothered

to plan ahead in times of emergencies so that these public housing residents get the right amount

of medical aid. To add, these organizations still do not have plans in place when the next event or

disaster strikes. About 50% of adults living in public housing in New York City lived alone and

79% had two or more chronic health conditions (Chavkin, 2013). These vulnerable residents

were trapped in buildings for a long period of time in the dark and with little to no aid from the

city (Chavkin, 2013). It is important to address the needs of everyone especially the at-risk

populations. Authors, Sophia Jan and Nicole Lurie, add that public health officials in disaster

preparedness emphasize the need to have strong systems laid out and “the need to build

community disaster resilience and reduce long-term vulnerability” (Jan & Lurie, 2012). This

article stresses the need to shift into a more technologically savvy world by highlighting the

benefits of electronic records and new technology in general. In order to do build community

resilience, we must focus on implementing and supporting health information systems, like

creating electronic medical records. This would allow individuals with disabilities to still receive

treatment and medication at home because their medical records would be accessible. In

addition, electronic records would create a better and smoother system of coordination for caring

for disabled individuals. Adopting a more technological approach to accessing information can

improve the quality of care and improve communication (Jan & Lurie, 2012). For example,

creating more reliant home generators can help charge equipment or tools that people with

functional needs, need (Jan & Lurie, 2012). Better community resilience is not only found in the

development of technology but also the integration and involvement of people with functional

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needs to be a part of the emergency preparedness and response planning so that federal, state,

and local officials can assess the problems that they may have so that they will be able to avoid

any future problems when a disaster occurs. Finally, laws and policies should be passed and

emphasized that target disabled individuals. Becoming more reliant on better technology and

laws would create stronger community resilience which, in turn, would address the population

at-risk and prevent any injuries or illnesses (Jan & Lurie, 2012). Besides addressing the the

needs of the vulnerable population in response to a crisis like Hurricane Sandy, it is necessary to

focus on the potential mental health risks that can manifest in certain groups or populations. Dr.

Yuval Neria and Dr. James M. Schultz illustrate the effect of being exposed to a disaster and the

mental health problems that may form, depending on the severity of the disaster (Neria & Shultz,

2012). Furthermore, factors of race, ethnicity, disability status, etc., contribute to the

development of develop mental health problems after being exposed to a crisis. The aspect of

focusing on the potential mental health risks in affected populations is needlessly overlooked.

This article helps introduce ways to prevent and alleviate the burden of mental health risks from

a disaster like Hurricane Sandy. In this way, affected and vulnerable populations should be

closely monitored so that they can be treated effectively. In addition, those who had a mental

illness before the storm and those who are at risk for developing a mental illness linked to crisis

or disaster like PTSD should also be treated with proper care (Neria & Shultz, 2012). But most

importantly, prevention above anything else is the best strategy to avoiding unnecessary actions

or plans. A few ways to address this is to let the others know that they are safe by creating a

strong support system which would lessen the tension and ease the stress that they may have

from the disaster. Reducing stress could ultimately decrease the risk of developing a mental

illness like anxiety or depression (Neria & Shultz, 2012). In an article called “Overcoming the

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Challenges of Protecting Vulnerable Populations During a Disaster”, writer Noah Reiter

explains the challenges of helping a vulnerable population and the solutions to address this. Like

authors Neria and Shultz, Reiter argues that when helping at-risk populations, it is necessary to

include them and encourage them be a part of the whole community to gain their trust and

participation throughout this whole event. One way to do this is to introduce and encourage them

to join advocacy groups or other organizations (Reiter, 2014). Increasing trust allows them to

communicate with the rest of the community and government officials about their needs. The

devastation that Hurricane Sandy has caused illustrates the positive impact of prevention

methods in populations affected by the crisis especially vulnerable populations. Authors Irwin

Redlener and Michael Reilly, emphasize the importance of working as a team. For example,

patients would not be cared for if there would be little to no resources available or knowing

where the elderly or disabled can help responders monitor their health status and distribute any

resources that they may need (Redlener & Reilly, 2012). Having the proper resources and better

communication could not only ease the burden of first responders, for instance, but also the at-

risk populations that may need the most aid. To add, addressing a number of individuals who not

only have physical disabilities but possibly not speaking English or may have mental disabilities

is challenging but we must work to understand and communicate effectively with them. For

example, not everyone can hear or see so it is important to accommodate to everyone’s needs by

having messages that address these issues like having messages in Braille or videos with subtitles

(Reiter, 2014). These various events and problems vulnerable populations faced is just one of

many lessons from Hurricane Sandy that our country needs to learn and improve from to prevent

this from happening in the future.

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Nevertheless, the aftermath of Hurricane Sandy was certainly eye opening for many and

the federal government has in many ways, taken bigger steps to address the situation in response

to the disaster. John Manuel describes the necessary steps taken in the aftermath of Hurricane

Sandy that would prevent any future problems. For example, President Obama passed the

Disaster Relief Appropriations Act “which provides $16 billion in Community Development

Block Grant Disaster Relief funds to repair and restore areas affected by Hurricane Sandy”

(Manuel, 2013). Obama along with other states such as New York and New Jersey have

advocated to build resilience among affected communities which allow them to be prepared for

future disasters. The main goal is to improve resiliency across all domains which means “getting

people back into their homes and apartments, restoring business and community

infrastructure…”(Manuel, 2013). Although it is not an easy task at hand, the government shows

that they have come a long way by learning about the mistakes that could have been avoided.

Even though there were many failures in terms of coordination, communication, and ability to

provide aid to certain populations, there were some lessons learned from previous disasters like

Hurricane Katrina.

In conclusion, there were many mistakes during Sandy that provide a window of

opportunity to learn from to avoid future mistakes. The problem lay mostly in the

communication and coordination efforts between the public health infrastructure and

government, and the community. This lack of communication between healthcare professionals,

first responders, government and the community illustrates America’s need to create programs

and procedures to ensure these mistakes will not happen in the future. The roles of FEMA, the

National and Coast Guard, especially in disaster events like Sandy is necessary as well as

emphasizing the need to work as a team with the community and public health officials to

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provide the necessary supplies to survive. Sandy taught us that everyone’s needs and health

should be addressed which includes at-risk populations who need help the most and it most

importantly showed the need to have plans in place especially in hospitals where there many be

an influx of patients that need to be cared for. Apart from this, it also showed the need to use

social media as a platform for communication so that everyone was updated with news. The

lessons learned from this event will help better our public health infrastructure and save the lives

of many.

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Work Cited

Abramson, D.M., & Redlener, I. (2012). Hurricane Sandy: Lessons Learned, Again. Disaster

Medicine and Public Health Preparedness Disaster Med. Public Health Prep., 6(04),

328-329.

Bucci, S., Lesser, J., Inserra, D., Mayer, M.A., Slattery, B., Spencer, J., & Tubb, K. (2013,

October 24). After Hurricane Sandy: Time to Learn and Implement the Lessons in

Preparedness, Response, and Resilience. Retrieved March 12, 2016, from

http://www.heritage.org/research/reports/2013/10/after-hurricane-sandy-time-to-learn-

and-implement-the-lessons

Chavkin,S. (2013, February 1). Lack of Authority, Retrieved April 2, 2016, from

http://www.thenewyorkworld.com/author/schavkin/

Cohen, S. E. (2013, March 7). Sandy Marked a Shift for Social Media Use in Disasters.

Retrieved April 12, 2016, from http://www.emergencymgmt.com/disaster/Sandy-Social-

Media-Use-in-Disasters.html?page=2

Jan,S., & Lurie,N. (2012). Disaster Resilience and People with Functional Needs. New England

Journal of Medicine N Engl J Med, 367(24), 2272-2273. Retrieved April 1, 2016.

Manuel, J. (2013). The Long Road to Recovery: Environmental Health Impacts of Hurricane

Sandy. Environmental Health Perspectives, 121(5). doi:10.1289/ehp.121-a152

Neria, Y., & Shultz, J. M. (2012). Mental Health Effects of Hurricane Sandy. Jama,308(24),

2571. doi:10.1001/jama.2012.110700

Powell, T., Hanfling, D., & Gostin, L.O. (2012). Emergency Preparedness and Public Health:

The Lessons of Hurricane Sandy. Jama,208(24), 2569. Retrieved March 12, 2016.

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Redlener, I., & Reilly, M.J. (2012). Lessons from Sandy-Preparing Health Systems for Future

Disasters. New England Journal of Medicine N Engl J Med, 367(24), 2269-2271.

Reiter, N. (2014, October 7). Overcoming the Challenges of Protecting Vulnerable Populations

During a Disaster. Retrieved April 22, 2016, from

http://www.emergencymgmt.com/disaster/Overcoming-Challenges-Protecting-

Vulnerable-Populations.html