At 2:46 p.m. on Tuesday, Oct. 30, 2012, the second day that Hurricane Sandy was battering New York City and New Jersey, Scott Aronson '92 received an email from a contact at the U.S. Department of Health and Human Services.

"Quick question," it read. "Are you facilitating evacuations in New York, New Jersey, and Connecticut?"

Aronson, a principal with Russell Phillips & Associates (RPA), which handles fire and emergency management for health care facilities, then received a message from the Healthcare Evacuation Center in New York City at 2:52 p.m., based on earlier communications: "We welcome and want to take you up on your offer. Call me ASAP." He learned that New York City was preparing to evacuate 2,000 patients with nowhere to move them.

RPA contracts mutual aid plans for health care facilities, primarily in Connecticut, Washington state, western New York and Massachusetts, to prepare them in advance for infrastructure failure and a catastrophic surge in which large numbers of patients arrive and tax the system. For the New York City emergency, the company's database revealed how many beds were available, and where.

In response to the New York City request, Aronson contacted the office of the commissioner of health in Connecticut. "We needed to make sure all barriers were removed to move that many people," he says. Both Connecticut and New York agreed to remove all impediments to getting it done.

"Then we activated," says Aronson. "We decided that any facility in Connecticut on emergency power would not receive patients at that time. We only took facilities that had open beds and were accessible. Secondly, we realized that because of the scope of the emergency, we needed to be prepared for other evacuations, so we did a prioritization."

Aronson emailed the breakdown, including the names of facilities, addresses, number of beds, types of patients the facilities could handle, and contact information so the Healthcare Evacuation Center could reach out directly to those facilities.

But, at 5:03 p.m., Aronson says, "They stood everything down. There was a direct communication from the governor of New York to Connecticut that there would be no influx of patients from New York. They were at a break point, but there were realistic concerns that the risk of transporting nursing home patients such extended distances might outweigh the benefits. Every time a health care patient evacuates, you have substantial risks because of medical needs and the psychological issues involved with being moved from a place where they feel safe and comfortable to a new and strange location. There is no silver bullet in making these decisions, and there can be negative outcomes whether you shelter-in-place or evacuate."

Unfortunately, in this case, thousands of elderly, disabled and mentally ill residents in the high-risk facilities that did not evacuate in Brooklyn and Queens were temporarily trapped without lights and heat. Many other long-term care facilities did evacuate in New York, however, and Connecticut and Rhode Island evacuated four health care facilities—three of them substantially in advance of the storm, and one during the storm. "We were involved in making sure the Connecticut facilities had the right bed information and there was availability to receive evacuated patients," Aronson says.

This was not the first time RPA addressed a weather emergency. Coordinating health care facilities for Hurricane Irene in 2011, the company provided support to more than 300 long-term care facilities and 14 hospitals in Massachusetts, and 79 nursing homes in Connecticut.

Planning happens well before an emergency strikes. Each year RPA goes through large-scale disaster simulation exercises with the facilities in its mutual aid plan. The company writes the scenario, orchestrates it, and partners with local emergency, state or regional management to make sure the health care facilities can handle everything, with support, and to test potential failure of the infrastructure of the region.

"In Sandy, one of the challenges was that facilities were evacuating all over the place," says Aronson. "When that's happening, you have patients leaving via bus, van, ambulance." Facilities may be overwhelmed, patients may have to be diverted, medical records and identification may be misplaced.

And the basics may be missed. RPA recommends a redundant—both electronic and paper—system. "Otherwise, you may end up with a patient arriving at a facility with no one knowing where they came from and with no medical records," explains Aronson. "The patient may say, 'I take a blue pill.' But what pill? For what? Imagine being the health care provider in that situation." ~