Hurricane Sandy power crisis and evacuation at Bellevue Hospital

The Hurricane Sandy power crisis and evacuation at Bellevue Hospital was a near-failure that forced clinicians to prepare for choosing which critically ill patients would retain electrical support. Floodwater threatened both the hospital’s utility infrastructure and the fuel supply for its backup generators. A committee drew up a plan to ration six working outlets among 56 adult ICU patients, but an improvised effort to carry fuel upstairs kept backup power available and allowed the patients to remain supported during the evacuation. The crisis joined a practical escape from disaster to an ethical decision that, at the last moment, did not have to be made.

The Threat to Power

As Hurricane Sandy approached, a storm surge pushed toward the land around Bellevue Hospital Center from the East River. Dr. Laura Evans, the hospital’s medical director of critical care, was called to the emergency command center. Hospital leaders warned that flooding could disable pumps supplying oxygen and vacuum suction, as well as pumps moving fuel from large underground tanks to the backup generators. If city power failed, the small reserves attached to the generators on the hospital’s thirteenth floor would last only about two hours once the fuel pumps stopped working.

The prospect was especially dangerous in Evans’s 56-bed adult ICU. Nearly every patient depended on electrically powered equipment; some were on life support, others relied on intravenous drugs to regulate their heartbeats and blood pressure, and some used intra-aortic balloon pumps to maintain circulation. The threat was not simply that the building might go dark. A power interruption could remove essential support from patients whose care depended on continuously functioning machines.

The situation also recalled earlier failures exposed by Hurricane Katrina. During the New Orleans evacuation, officials had urged residents to leave for the Superdome, even though transport plans had serious gaps and many residents lacked a way out. Acadian’s ambulances were overwhelmed with requests and some were stuck in traffic, while others took patients to the Superdome rather than out of the city. At Memorial Medical Center, the danger of a prolonged emergency had included the hospital’s inadequate backup systems. In New York, Bellevue’s leaders had more advance warning of the particular power risk, but that did not make the coming choices straightforward.

Preparing to Allocate the Outlets

The hospital command team believed that a generator in a neighboring building, with a more protected fuel pump, could continue operating. It could supply exactly six outlets in the ICU. Evans was asked to produce a list of which patients should receive them. Fifty-six patients required electrical support; the possible refuge was six outlets. What had been an infrastructure problem became a question of how to distribute a resource that could sustain life.

Evans had access to the New York State ventilator-allocation planning document, developed after the Memorial arrests and amid concern that a severe influenza outbreak could force similar choices. Its scoring approach was designed for allocating ventilators during a pandemic, not for this specific power emergency. Evans nevertheless adapted the untested guidance because she needed a procedure to organize the decision.

She convened an ad hoc committee rather than making the choices alone. Its members included doctors, nurses, and ethicists, none of whom had a patient under consideration. That separation was meant to let each primary doctor continue advocating for an individual patient while the committee considered the broader allocation according to defined criteria. The process included professional perspectives but not patients or family representatives. Within about two hours, the committee had produced its list, communicated the decisions to staff, and planned how to move patients between beds and outlets. Some staff questioned the choices but accepted the process.

Evans also considered whether she could later explain the decision to families and to a public that might scrutinize it. She wanted a transparent process applied consistently, in part because she knew the story of Anna Pou and the controversy following Katrina. The allocation plan was therefore both an emergency measure and an attempt to make a frightening judgment defensible. Yet preparing the list did not resolve how the people who would lose access to power—or their families—should be told. Staff feared that conversation and postponed it; they also did not consider asking whether a patient or family might volunteer to relinquish an outlet.

The Outage and the Improvised Response

As Evans and her colleagues completed the list, the lights went out. Backup generators took about seven seconds to start, restoring power, but the command center then warned that all but the six protected outlets might be lost within 60 to 90 minutes. Millions of gallons of floodwater were entering the hospital basement, and water rushed into elevator pits forcefully enough to dislodge elevator doors. The committee’s contingency planning had become immediate: the hospital was preparing for a wide power loss while the building’s lower levels flooded.

Staff prepared to sustain patients manually if equipment failed. Two health professionals were stationed at the bedside of each ventilator-dependent patient, ready to use manual resuscitation bags to push oxygen into the lungs. Bright-orange extension cords from the backup generator system ran through patient corridors. Nurses counted drops on intravenous pumps so they could deliver vasopressors by drops per minute if the pumps stopped working. These preparations converted the abstract possibility of equipment failure into bedside tasks carried out patient by patient.

The feared cutoff was prevented not by the six-outlet plan but by a chain of volunteers carrying fuel up thirteen flights of stairs to feed the generators manually. That rapid improvisation kept the backup power from failing. Evans’s patients remained on generator power while the evacuation proceeded, and the committee did not have to carry out its proposed allocation of six outlets. The list had organized a possible crisis; the fuel chain changed the conditions that made the list necessary.

Evacuation and Significance

With elevators out of service, moving patients from the large hospital took days. The evacuation raised its own difficult questions about the people most challenging to move. Two patients were kept until last: one weighed about 600 pounds, and staff were concerned about transporting him without functioning elevators; another was extremely ill and fragile, and his doctors feared he might die during the transfer. Their vulnerability made the evacuation’s practical limits visible even after the immediate power threat had been contained.

The hospital did not abandon the effort. After other patients had been rescued, soldiers carried fuel up the stairs for several more days, until the elevators could operate again. Doctors performed heart surgery on the fragile patient inside the disabled hospital. Both he and the patient who weighed about 600 pounds were safely moved to another hospital. The outcome depended not only on the initial allocation plan but on continued work to preserve power, provide care, and complete a slow evacuation under damaged conditions.

The Bellevue episode revisits the dilemma raised at Memorial Medical Center during Katrina, while showing a different ending to the threatened rationing. Evans’s team made a plan for distributing scarce power, but manual fuel delivery prevented the predicted loss that would have forced the plan into use. The contrast does not erase the ethical difficulty of decisions made under emergency conditions: the committee excluded patients and families, and staff deferred telling those who might not receive an outlet. It does show how contingency, improvisation, and evacuation shaped which ethical choices became necessary. The event’s central reversal is stark: the hospital prepared to decide who could keep life-sustaining equipment, then preserved power long enough that the decision did not have to be imposed.