Hurricane Sandy: Evaluating Preparation Strategies and Response Efforts in a Time of Crisis
Dr. Joseph Costa, D.H.Sc., PA-C
Health Policy and Management
MPH 525
Jennifer Hansen
April 2014
Table of Contents
Chapter
Page
1. Introduction .................................................................................................................................3
2. Hurricane Sandy..........................................................................................................................5
The Storm.............................................................................................................................5
Physical and Economic Impacts ..........................................................................................5
3. Public Health Collaboration Efforts and Challenges ..................................................................7
Federal Emergency Management Agency (FEMA) ............................................................7
The American Red Cross and Volunteers ............................................................................9
The National Guard............................................................................................................10
Emergency Medical Services/Hospital Personnel/Local Community ...............................10
4. Conclusion ................................................................................................................................12
Summary ............................................................................................................................12
Recommendations ..............................................................................................................13
References .....................................................................................................................................15
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Chapter 1
Introduction
“Preparedness” and “response.” These two terms are widely discussed when evaluating
the efforts of public health agencies and emergency response personnel during the crisis of a
natural disaster. The ability of federal, state, and local public health, law enforcement, and
emergency response agencies to work together during the time of preparing for and responding
to a natural disaster is often a key factor when weighing the impacts felt by the community.
Public health officials in all levels of governmental agencies study and design the process of
preparing for natural disasters long before they strike. While public health agencies are charged
with designing effective disaster preparation and relief strategies, their collaboration with local
law enforcement and emergency service agencies give the ability for these strategies to be
carried out in real time disaster situations. Without these crucial preparation strategies and their
efficient implementation, the devastation felt by the community during and after such disasters
would be magnified exponentially. In turn, while advanced preparation greatly reduces the
amount of damage done and the residual effects of a natural disaster, the response by public
health officials and emergency response personnel during and after the disaster strikes is also
paramount in determining how heavy the impact will weigh on the community and surrounding
areas.
One of the greatest examples of a crisis resulting in profound efforts displayed by state
and local public health agencies in collaboration with local law enforcement agencies and
emergency service providers occurred when Hurricane Sandy struck the east coast of the United
States on October 29, 2012. Additionally, the federal government, while accused of taking a
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reactionary versus a proactive approach to the effects of the storm known as Hurricane Sandy,
did provide the funding necessary for disaster relief and recovery efforts to occur. For those
involved in Hurricane Sandy, the collaboration efforts and failures between federal, state, and
local public health agencies and emergency response teams made the difference not only
between life and death, but also the ability to regroup, repair, and rebuild their lives and
communities.
While preparation and response efforts made by all levels of public health agencies and
private organizations, state military forces, emergency medical responders, volunteers, and
members of the local and surrounding communities were remarkable and hugely impactful,
much can still be learned from the events of Hurricane Sandy about proper and early storm
warnings and evacuation strategies, the discretionary use of federal funds for relief and
rebuilding, and the utilization of our valuable state resources, such as the United States’ National
Coast Guards, emergency response teams, and local volunteers to aid in rescue and recovery
operations.
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Chapter 2
Hurricane Sandy
The Storm
Beginning on October 22, 2012, a full week before Hurricane Sandy hit the eastern coast
of the United States, the National Oceanic and Atmospheric Administration (NOAA) and the
National Weather Service began issuing public advisories throughout the day, indicating an
observed tropical depression had met the requirements necessary to label it a full tropical storm
(FEMA, 2013). In the days that followed, the storm strengthened in size and force, sustaining
wind speeds of over 80 miles per hour by the time it struck land on October 29th, leaving a wake
of destruction in its path (National Weather Service Forecast Office, n.d.). With the storm’s
arrival coinciding with a seasonal and abnormally high tide and coupled with high winds and
record-level storm surges, Hurricane Sandy caused lasting damages that are still being felt
throughout the affected communities and surrounding areas. Although the impacts of the storm
were felt throughout 24 states in the U.S., the most heavily affected by high storm surges
accompanied by rising floodwaters were New Jersey, New York, and Connecticut (Toro, 2013).
Physical and Economic Impacts
The effects of Hurricane Sandy on the people in New Jersey, New York, and Connecticut
were widespread and are still being felt. Community members experienced loss of life, homes,
electrical power, and infrastructure, as well as the trauma from evacuations and fear. According
to the Centers for Disease Control and Prevention (CDC), direct and indirect deaths of
individuals just in the United States resulting from the onslaught and aftermath of Hurricane
Sandy toll 117 (CDC, 2013). Of those 117 deaths, 40 resulted from drowning, and 45% of those
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drowning deaths occurred in flooded homes in Evacuation Zone A, indicating individuals’
inability or unwillingness to leave their homes during this time of natural disaster (CDC, 2013).
Other fatalities resulted from high wind speeds, structural collapses, hazardous road conditions
and gas shortages, and loss of electrical services.
While fatalities are certainly the most tragic result of any natural disaster, Hurricane
Sandy left masses of destruction and dangerous living conditions for survivors of the affected
areas as well. In fact, the storm left over 23,000 people in search of temporary shelter due to
flooding and collapses in infrastructure, with 8.5 million people experiencing power outages for
days after the disaster (FEMA, 2013). Others experienced severe gas shortages and hazardous
road conditions, preventing travel and further evacuation of the affected areas. Financially,
Hurricane Sandy was the largest Atlantic hurricane ever recorded and ranks as the second most
expensive hurricane in United States history, costing over $65 billion in damages and repairs
(Ladislaw, Kostro, & Walton, 2013).
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Chapter 3
Public Health Collaboration Efforts and Challenges
Federal Emergency Management Agency (FEMA)
Prior to Hurricane Sandy’s arrival on the east coast, FEMA collaborated with the
Department of Defense in order to establish two Incident Support Bases (FEMA, 2013). These
bases dispensed and positioned supplies, generators, communications vehicles, and other
resources in areas thought to be in high risk zones. FEMA continued to provide these necessary
supplies all over states affected by the storm, including over “20 million liters of water, 16
million meals, 1.7 million blankets, 79,000 cots, 138,000 tarps, 500 generators, and 100 infant
and toddler kits” (FEMA, 2013, para. 7). In addition, FEMA made preparatory provisions of
$1.3 billion to aid emergency protective measures, collaborating with first responders and
funding costs for expected personnel overtime and materials and equipment necessary for safe
and effective disaster relief (FEMA, 2013).
Once Hurricane Sandy made landfall, rising water levels flooded roadways and subway
tunnels and brought damaging winds to the coastal infrastructure. In response, FEMA provided
funding and assistance for debris removal and dewatering of tunnels and subway systems. In the
days, weeks, and months following immediate clean-up efforts, FEMA dispensed nearly $402
million to the New York City Department of Environmental Protection for emergency repairs to
homes, and infrastructure repairs to waste water treatment plants, pump stations, drinking water
facilities, and sewers that allowed survivors to remain in their disaster-damaged homes while
repairs were being made (FEMA, 2013).
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Although FEMA provided major sources of funding and services in order to aid in the
clean up and restoration of the communities impacted by Hurricane Sandy, there were areas in
which the agency fell short of expectations. Due to severe power outages and failure to
implement an effective back up plan for accessing fuel storage systems, the impacted areas also
experienced a detrimental shortage of gasoline and diesel fuel (Sanati, 2012). The fuel shortage
was further exacerbated by federal regulations set forth in the Jones Act of 1917, which prohibits
the transfer of goods between U.S. ports unless the cargo ship was made in the U.S., registered in
the U.S., and staffed by an all-American crew, showing the political red tape that often times
hinders recovery efforts in the event of a natural disaster (Sanati, 2012). The federal government
did come to a decision to waive the Jones Act in this situation and allowed the passage of
gasoline tankers into nearby ports to provide the fuel needed to carry out restoration efforts. In
order to further solve the fuel-shortage issue, FEMA drew on resources through the entire
country to provide hundreds of power-restoration vehicles and utility personnel in order to repair
damages to the regional utility and fuel-distribution infrastructure (FEMA, 2013).
To begin rebuilding efforts, the regional communities most heavily impacted by
Hurricane Sandy received more than $3.2 billion in federal funds through FEMA for projected
focused on debris removal, repair and replacement of infrastructure, and future emergency
protective measures (FEMA, 2013). Due to the severe amount of flooding brought on by
Hurricane Sandy and its devastating impacts, FEMA obligated more than $74 million in hazard
mitigation grants to “prevent or minimize future damages through projects that include elevating
buildings and acquiring structures in flood-prone areas, and assisting in the development of
county mitigation plans” (FEMA, 2013, para. 12). Included in these projects is a program
designed to directly assist the local communities in increasing their knowledge base and personal
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preparedness for potential future hurricanes. This program aimed at gathering and delivering
revised flood risk information to the region, and empowering communities and property owners
to make more informed decisions about rebuilding and recovery that will increase their resilience
to future disasters (FEMA, 2013).
The American Red Cross and Volunteers
The teamwork and collaboration efforts between federal agencies and organizations such
as the American Red Cross bridged the gap between funding and action, and while much of the
funding for the restoration and rebuilding of the communities came from government agencies,
the American Red Cross was a key player in both funding and relief efforts for the survivors of
Hurricane Sandy. The American Red Cross received donations in excess of $308 million from
all over the entire country to assist with disaster relief efforts, making it possible for them to
deploy more than 17,000 trained workers from all over the country, 90 percent of whom were
volunteers, to aid the impacted region (IFRC, 2013). According to the one-year anniversary
report by the International Federation of Red Cross and Red Crescent Societies, additional efforts
by the Red Cross included:
– Serving more than 17.5 million meals and snacks in a huge feeding operation.
– Handing out more than 7 million relief items such as cold weather items and
clean-up supplies.
– Providing nearly 113,000 health services and emotional support contacts for
people who have been living in very tough conditions.
– Providing 74,000 overall shelter stays for Sandy. (IFRC, 2013, para. 6-8)
With workers and volunteers taking part in relief efforts on the ground in the affected
areas, the American Red Cross also provided $60 million in grants to various nonprofit
organizations in New Jersey and New York to assist local individuals with home repairs, mold
remediation, food, financial assistance, and financial counseling following the storm’s
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devastation (IFRC, 2013). According to the IFRC (2013), excess donations not dispersed for
direct relief efforts in the weeks and months following the storm will likely be used to help
survivors with related housing expenses and to support future community resiliency programs to
make the area more prepared for future disasters.
The National Guard
While the federal government, private organizations, and volunteers all around the
country came to assist communities impacted by Hurricane Sandy, eleven surrounding states
mobilized over 7,400 members of the National Guard in preparation of the storm. National
Guard members were available to support evacuation efforts, clear roadways, deliver equipment
and supplies, and perform search and rescue missions (Greenhill, 2012). According to Army
Sergeant, Jim Greenhill (2012), the National Guard Bureau chief also attended FEMA briefings
and spoke with President Obama, indicating the National Guard’s response supporting state,
local, and federal agencies in Hurricane Sandy relief efforts. Furthermore, having learned from
the catastrophic events following Hurricane Katrina in Louisiana, the National Guard
implemented a newer strategy of utilizing “dual-status commanders”, who are generals with both
state and federal authority (Bucci, et al., 2013, p. 4). This reduces redundancies in paperwork
and organization and allows for the streamlining of troop coordination in order to provide timely
and effective assistance.
Emergency Medical Services/Hospital Personnel/Local Community
Assistance in the form of federal funding and provisions, private organizations, and state
military personnel were all essential in their collaborating efforts to assist survivors of Hurricane
Sandy in recovering and rebuilding their communities. However, another key component to the
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survival and resiliency of those affected by the hurricane is the partnership of the members of the
community involved. Although members of the regional emergency medical services (EMS)
boast their level of preparedness for the storm, they also credit the National Weather Service’s
advanced and accurate storm tracking and reporting (Busch, 2013). Such precise reporting
allowed them to tailor their specific plans for hurricane preparation and response, including
submitting an anticipatory request to the Emergency Management Assistance Compact (EMAC)
for out-of-state ambulances to come assist with healthcare facility evacuations in the affected
area (Busch, 2013). In doing so, inter-state EMS agencies faced and met challenges created by
variations in scopes of practice, forcing many EMS workers to educate each other and work
together to accomplish the task of rescuing survivors and clearing debris.
While EMS have found pride in their ability to prepare for such natural disasters, the
personnel of many hospitals in the affected areas found themselves largely unprepared for the
extent of the impact felt throughout their facilities. Unprecedented power outages and failed
backup generation systems forced the evacuation of hospitalized patients, calling for the
cooperation of medical and support staff, first responders, and National Guard troops with
hospital leaders and senior public health officials to transport patients from their rooms to
ambulances and then on to receiving hospitals (Redlener & Reilly, 2012). Extraordinarily, the
emergent evacuation of two separate hospitals, NYU-Langone Medical Center and Bellevue
Hospital, was carried out in the midst of raging winds and floodwaters without a single life lost
or medically apparent consequence.
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Chapter 3
Conclusion
Summary
Natural disasters take their toll on a community, not only in the physical sense, but also in
the affected area’s ability to recover, rebuild, and thrive as before. In an event as catastrophic as
Hurricane Sandy, it takes the highest efforts and collaboration of federal, state, and local public
health agencies, private organizations, emergency medical responders, and the community as a
whole to prepare for and repair the damages done. The ability of the NOAA and National
Weather Service to accurately predict the storm’s path in advance, federal and local public health
agencies’ early evacuation instructions, and the EMS and National Guard workforces’ strong
emphasis on preventive training for catastrophic events helped to prepare those in the way of the
storm for its devastating impact on their communities. Following the brutal shock and impact of
the storm, thousands of volunteers armed with provisions and funding by the American Red
Cross, along with local and out-of-state emergency responders foraged through the mess to aid in
clean up and recovery efforts. Furthermore, in the aftermath of the wreckage caused by
Hurricane Sandy, FEMA and the American Red Cross, with help from many other charities,
began funding for the long-term rebuilding and revitalization of the communities most heavily
impacted by the storm. While there were many places in which one could claim these entities
failed the affected regions due to failures to foresee potential for long-term power outages, fuel
shortages, and emergency hospital evacuations, the incredible dedication of time and work put
into preparing for Hurricane Sandy and repairing and restoring the community to its previous
status after the storm is nothing short of remarkable.
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Recommendations
Due to the large number of individuals who perished inside their homes due to flooding
in evacuation zones, I first and foremost recommend greater emphasis to be placed on educating
communities in danger zones on the damaging nature and force of hurricanes and the risks of
remaining in an evacuation zone. Although there is no way to force people to leave their homes
against their will, there should be no excuse for those who wish to leave to be unable to do,
especially because of financial hardship or lack of transportation. Every effort should be made to
deliver these individuals to a safety zone. Whether that is a temporary shelter where they can
either stay or are subsequently offered bus tickets to a friend or relative outside of the path of the
disaster, this is a simple way to reduce the amount of lives lost.
While flooding was directly responsible for the majority of the deaths during Hurricane
Sandy, rising water levels combined with high wind speeds were also indirectly responsible for
deaths due to resulting power outages. In my opinion, since the widespread loss of power
negatively affected so many procedures necessary for appropriate and effective storm response,
relief, and rebuilding, advancements must be and will likely be made in the electrical grid to
reduce the potential for loss of power during high-powered storms in the future. I believe the
implications of the power loss during Hurricane Sandy, including not only loss of heat and
electricity, but also the ability to utilize fuel and fuel stores, will provide the motivation
necessary to fund these changes in preparation for future disasters.
Because of stream-lined communication procedures and competency of the National
Guard to respond to a variety of situations and recovery efforts, they should be utilized in future
storm relief efforts nationwide. Since each state houses their own National Guard units, local
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troops are especially knowledgeable on the layout of the land and community structure, making
them even more beneficial during times of crisis. In addition, the nature and pace of their up-todate cooperative training for emergency situations makes them exceptional candidates for this
type of work. They are trained to keep their composure during emergencies, making them
physically, mentally, and emotionally beneficial to scared individuals affected by the disaster.
Finally, in light of the impromptu hospital evacuations due to the lack of adequate
resistance to rising floodwaters, hospitals in flood zones should be required to review and
evaluate their structural and staff and patient evacuation plans for future prevention of such
scenarios. Fortunately, the staff at both evacuated hospitals did a commendable job of
responding quickly to the threat of both floodwaters and loss of power. Since all lives were
preserved during crucial procedures, honorary staff members should use this experience to
educate and inspire staff at hospitals throughout the nation on how to remain composed and
organized in similar situations. Members of the hospital staff involved should also share their
stories with public health agencies in charge of assessing the integrity of flood-prevention
policies in hospitals across the country. In my opinion, doing so would help make light of a
terrifying situation by helping to prevent future occurrences.
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REFERENCES
Bucci, S.P., Inserra, D., Lesser, J., Mayer, M.A., Slattery, B., Spencer, J., & Tubb, K. (2013,
October 25). After Hurricane Sandy: Time to learn and implement the lessons in
preparedness, response, and resilience. The Heritage Foundation. Retrieved April 2,
2014 from http://www.heritage.org/research/reports/2013/10/after-hurricane-sandy-timeto-learn-and-implement-the-lessons.
Busch, J. (2013, March 1). A supersized storm. EMSWORLD. Retrieved April 1, 2014 from
http://www.emsworld.com/article/10875975/ems-response-to-hurricane-sandy.
CDC. (2013, May 24). Deaths associated with Hurricane Sandy – October-November 2012.
Retrieved April 3, 2014 from
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FEMA. (2013, October 28). Hurricane Sandy: Timeline and recovery efforts one year later.
U.S. Department of Homeland Security. Retrieved April 1, 2014 from
http://www.fema.gov/media-library/assets/documents/85068.
Greenhill, J. (2012, October 30). National Guard aids in Hurricane Sandy response. U.S.
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IFRC. (2013, November 4). Red Cross releases Hurricane Sandy anniversary report. Retrieved
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Retrieved March 31, 2014 from https://csis.org.
National Weather Service Forecast Office. (n.d.) Storm Summary for Hurricane Sandy. NOAA.
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Redlener, I., & Reilly, M.J. (2012, December 13). Lessons from Sandy – Preparing health
systems for future disasters. The New England Journal of Medicine, 367(24), p. 22692270.
Sanati, C. (2012, November 5). Was the gas shortage preventable? CNN Money. Retrieved
April 4, 2014 from http://finance.fortune.cnn.com/2012/11/05/gas-shortages-sandy/.
Toro, R. (2013, October 29). Hurricane Sandy’s Impact (Infographic). Livescience. Retrieved
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