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When Hurricane Sandy hit downtown Manhattan, three neighboring hospitals each made different decisions about when to evacuate. Across the metro region, more than five hospitals and over 20 nursing and assisted living facilities were evacuated, making this the central public health challenge of this calamitous event. It is a familiar story—a super storm comes ashore, infrastructure is overwhelmed, and healthcare facilities evacuate patients, with major delays in returning to normal functioning. Afterwards, policy makers evaluate lessons learned for the next disaster, but similar missteps are often repeated.

Although not identical, it is instructive to compare Hurricane Katrina with the still unfolding events of Sandy. Unlike in Katrina, New York hospitals had more detailed emergency plans. What seemed to be missing, however, were clear and consistent criteria to guide evacuation decisions. Evacuation decisions are complex—a decision to evacuate prematurely places patients at risk, while waiting too long can have devastating consequences. Public officials, in collaboration with facilities, should decide whether to shelter in place or risk transfer of fragile patients. Governors should consider early emergency declarations, including request for a formal “public health emergency declaration”, to reduce legal concerns and regulatory constraints. Federal, state, and municipal authorities can better prepare for the next disaster and have a duty to do so.

Publication Citation

Tia Powell, Dan Hanfling, Lawrence O. Gostin, Emergency Preparedness and Public Health: The Lessons of Hurricane Sandy, JAMA Online (November 16, 2012),