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New York City Council Hearing: NYC Hospitals Preparedness for Weather Emergencies

Laura Iavicoli, MD, FACEP, Deputy Chief Medical Officer, Health + Hospitals/Elmhurst, Senior Assistant Vice President for Emergency Management
Wednesday, October 27, 2021

Good morning Chairperson Rivera, Chairperson Borelli and members of the Committee on Hospitals and the Committee on Fire and Emergency Management. I am Laura Iavicoli, Deputy Chief Medical Officer at NYC Health + Hospitals/Elmhurst and Senior Assistant Vice President for Emergency Management at New York City Health + Hospitals (Health + Hospitals). I am joined this morning by Christine Flaherty, Senior Vice President of Office of Facilities Development and Mahendranath Indar Senior Director of Office of Facilities and Development at Health + Hospitals, as well as Robert Bristol Director of Health and Medical, Christina Farrell, Acting First Deputy Commissioner, and Megan Pribram Deputy Commissioner of Planning and Resilience at New York City Emergency management (NYCEM). I am happy to testify before you to discuss NYC Hospitals Preparedness for Weather Emergencies.

Hospitals play an essential role in planning for and responding to the needs of New Yorkers during any citywide emergency, particularly weather emergencies. In recent years, health care emergency management regulatory requirements have significantly increased since major disasters such as 9/11 terrorist attacks, Hurricane Katrina and Superstorm Sandy. To ensure the safety of its patients and staff, Health + Hospitals has extensive plans in place in the event of weather, public health, or other catastrophic emergencies. Health + Hospitals’ emergency operations/response plans are developed to address “All Hazards” with specific Incident Response Annexes and Guides for high probability and high impact events which include extreme weather events such as Coastal Storms, Extreme Temperatures, and Winter and Summer weather events. Each of our sites is required to conduct training and exercises to test and evaluate their plans. Planned exercises and actual response activations are reviewed to identify gaps and areas for improvement. Emergency operations/response plans are then revised to incorporate changes and improvements identified, as well as physical improvements including hardening of facilities, purchase of needed equipment and supplies, or training for staff.

Health + Hospitals uses an Incident Command System (ICS) to manage all disasters, emergencies and other incidents. The ICS is a national best practice for coordinating emergency response and allows for communication, coordination, and collaboration with other agencies. A Central Office Incident Management Team (IMT), embedded within the System’s ICS, is responsible for coordinating emergency response across the health system. The five main components of Incident Command are Command, Operations, Planning, Logistics and Finance and Administration. Once Health + Hospitals activates the ICS, internal and external notifications are made while information is gathered for situational awareness. Staff are assigned to their incident command roles, briefings are held providing the latest intelligence and an incident action plan is developed for the first operational period. This process repeats for each operational period throughout the activation. To facilitate coordination with our sites, regular WebEx meetings are convened with the cadence determined by the type and scope of the event, information is gathered, vetted and shared. Modes of communication used to share information with staff include Everbridge Emergency Alert System that send messages via phone, email and text message; Health + Hospitals Intranet; Outlook emails; Emergency Alerts Intranet Blog; and Alertus, the System’s immediate emergency alert notification across facilities via pop-ups and ticker tape desktop messages. Once activated, the cadence of meetings within Central Office Incident Management Team and Site Leadership is established. A typical cadence of meetings would be daily morning calls with all senior Central Office leadership, chain of communication from our facilities to central office with their needs, daily System Site Leadership logistics and Planning touch bases, and broader Systemwide leadership briefings weekly. Additionally, all-staff webinars and emails are implemented to disseminate important information to all-staff. Similarly, for preparation and planning of an emergency, Health + Hospitals also utilizes the ICS. Trainings and exercises take place regularly where each facility tests components of the Emergency Operations Plan (EOP) to ensure operations and communication chains run smoothly.

Health + Hospitals has been activated in response to the COVID-19 pandemic since January 2020. During this time, we have had to concurrently respond to multiple other emergencies including coastal storms, four winter storms, mass transit shut down, extreme heat, civil unrest and staffing issues early in the COVID response. Health + Hospitals has maintained operations throughout each emergency event and provided continuity of care to our patients and communities we serve. With the evolution and implementation of ET3, Health + Hospitals has been able to care for patients who call for 911 safely from their homes during times of emergencies, via telemedicine. Although the ET3 program begin during the height of the pandemic, it is also useful in times of weather emergencies. This program allows for the City to prioritize emergency services to those with more emergent needs, while re-directing lower acuity 911 calls to the appropriate level of care through additional options such as telemedicine.

However, we do not work alone. Health + Hospitals works closely with City Hall and NYC Emergency Management (NYCEM) in all phases of emergency management including planning, mitigation, response, recovery, and training and exercises. We are a part of the ESF-8 Health and Medical branch of NYCEM. If NYCEM activates their Emergency Operations Center, Health + Hospitals has a representative serve as a liaison to facilitate communications, gather and disseminate information, and request and provide resources. Additionally, Health + Hospitals sits on several committees and work groups convened by NYCEM: ESF-8 Work Group, Citywide Logistics Committee, Shelter Planning Committee, Continuity of Operations work group, Urban Area Work Group, Coastal Storm Steering Committee, Winter Weather Steering Committee, and Heat Emergency Steering Committee. Each year, Health + Hospitals participants in exercises with other agencies and led by NYCEM. The intent of these exercises is to test plans and identify gaps however real-life activations also serve this purpose and allow for real time identification of gaps and resolution of issues. Scenarios for past NYCEM exercises include snow storms, transit disruption, nuclear attack, and coastal storms. In addition, Health + Hospitals partners with other hospital systems in NYC through the Greater New York Hospital Association (GNYHA) to prepare for emergency events. Health + Hospitals is a voting member of the NYC Health Care Coalition Governance Board led by the NYC Department of Health and Mental Hygiene (DOHMH). Health + Hospitals is a Network Healthcare Coalition and each of our acute care sites participate in borough healthcare coalitions with hospitals, nursing homes, and other community partners.

In the aftermath of Superstorm Sandy, Health + Hospitals understood the importance of recovery services. Our sites that incurred flood damage made major improvement measures including moving critical infrastructure to higher floors, flood protection for our facilities, flood resistant infrastructure, investing in generators, electrical panels, HVAC systems, and other capital projects. Additionally, we entered into a systemwide recovery services contract, with Northstar. Northstar will assist our System in getting back to normal operations in the aftermath of a disaster including assisting with pumping flood water, repair of utilities, implementation of flood mitigation equipment, additions of generators and movement of essential equipment to higher floors to mitigate flood damage.

Most recently, during Hurricane Ida Health + Hospitals collaborated with NYCEM, DOHMH and GNYHA on a situational awareness for a post storm impacts survey. The cross regional event allowed us to query sites in real time about impacts to supplies, infrastructure, Staffing, System and Utilities ED Volume, Command Center status, medically vulnerable community members, non-patient sheltering, and other comments. It helped to inform local agencies of system status (i.e.: EMS- FDNY) and allowed for System situational awareness within NYC System and to NYC and NYS DOHMH.

Health + Hospitals is committed to keeping its patients, staff, and infrastructure safe from natural disasters. Thank you for your attention to this important topic; we are happy to answer any questions you may have.