North Shore-LIJ Health System

North Shore-LIJ Health System was a nonprofit parent company operating sixteen hospitals across New York and Long Island. During Superstorm Sandy, it coordinated preparations through a local command center and offered assistance to hospitals beyond its own system. The episode marks a contrast with the fragmented support described during Hurricane Katrina, but not a story of complete preparedness: even as North Shore-LIJ organized a regional response, some staff had not planned for a total failure of backup power.

Identity and Organizational Reach

The system’s scale shaped both the demands on its leaders and the value of central coordination. Its sixteen hospitals were spread across New York and Long Island, placing the corporate command team in the position of monitoring threats at multiple facilities while also considering requests for help from outside the system. During Sandy, that reach made it possible for the organization to offer assistance beyond its own hospitals, a capacity the book contrasts with the support available to hospitals operated by Tenet Healthcare and LifeCare during Katrina.

The comparison does not make the two disasters or the institutions interchangeable. North Shore-LIJ appears in the account as a later example of more active coordination, not as a participant in the New Orleans crisis. Its significance lies in what the system did during Sandy and in the unresolved vulnerabilities its preparations exposed.

Command and Preparation During Sandy

On the night of October 29, two months after the book’s account of the Katrina crisis, a North Shore-LIJ executive entered a meeting of doctors at the system’s command center. New York University Langone Medical Center was seeking ambulances to evacuate four critically ill babies from its neonatal intensive care unit during the storm. The request made the regional nature of the emergency immediate: a hospital outside North Shore-LIJ was asking for transport help while the system’s own facilities also faced danger.

The executive’s team was already tracking conditions at its hospitals. At Southside Hospital in Bay Shore, water was rising, with high tide expected within about an hour. Earlier, corporate leaders had contacted Southside and Staten Island University Hospital to discuss what to do if backup systems failed and part or all of either facility lost power. At Staten Island, an official warned that part of the power system was below ground and could not be used if flooding reached it. Doctors at the command center put priorities on a whiteboard, including establishing a clinical command structure and triage. These were concrete preparations for a crisis that could interrupt essential hospital operations.

As the coastal threat approached, workers piled sandbags and operated pumps to protect electrical switch gear. The two North Shore-LIJ hospitals narrowly avoided calamity. That outcome mattered, but it did not erase the uncertainty leaders had been confronting: the protective work had to continue as the clock ran down toward high tide, and the hospitals’ ability to function depended on vulnerable electrical infrastructure.

The Backup-Plan Gap

The command center’s organization was a marked improvement over the weak coordination described in the Katrina response. North Shore-LIJ offered proactive and substantial assistance to its own hospitals and to others in the region. Yet the book also records a consequential limit: some staff members said they had never considered what to do if the backup plan to the backup plan failed and a facility lost all power. The omission was not unique to North Shore-LIJ; the account says it persisted in many places examined after Katrina.

That gap distinguishes having a command structure from having prepared for every stage of system failure. Leaders could identify rising water, discuss threatened power systems, and protect switch gear, while still confronting an outcome for which some staff had no plan. The narrative uses this tension to show that preparedness is not a finished condition secured by a control room or a written procedure. Under pressure, a system’s vulnerabilities include not only the equipment exposed to flooding but also the limits of what its people have anticipated.

Katrina in Retrospect

The book sets the Sandy response against the failures revealed during Katrina, when New Orleans hospitals faced evacuation and infrastructure problems amid a citywide emergency. The mayor’s evacuation order left hospitals open, while residents without transportation and patients needing medical transport faced severe obstacles. Ambulances were caught in traffic, and some patients were taken to the Superdome rather than out of the city. More broadly, the disaster’s consequences were attributed to delayed evacuation, insufficient transportation, uncoordinated rescue, poor communications, and hospitals and nursing homes that had not made backup power and water systems robust enough for a prolonged emergency.

The contrast is especially clear in the account of Memorial Medical Center and the public Charity Hospital. Memorial’s patients were ventilated by hand after power failed, while generators were later used for lights and fans in common areas rather than medical equipment. Charity, despite flooding, loss of power and other services, and a larger patient population relative to its staffing, had prepared portable generators and used them to power ventilators and cardiac monitors. Its leaders also maintained regular briefings and hospital routines, and took the sickest patients out first. These examples are not North Shore-LIJ’s own record; they supply the earlier history against which its Sandy command center is assessed.

Significance and Unresolved Risk

North Shore-LIJ’s response demonstrates a real change in the organization of disaster support: a system-level command center coordinated attention across sixteen hospitals and could assist facilities beyond its corporate network. But the account resists treating that progress as proof that the deeper problem had been solved. During Sandy, hospitals still faced the possibility that floodwater could disable electrical systems, and some personnel had not planned for complete power loss. The two coastal hospitals escaped catastrophe through timely protective efforts, while the broader uncertainty remained.

In the book’s wider argument, emergencies expose weaknesses that ordinary operations can conceal: dependence on interconnected infrastructure, incomplete planning, and difficulty anticipating what happens when safeguards fail. North Shore-LIJ is therefore presented neither as a repeat of the Katrina-era institutional failures nor as a model beyond criticism. Its organized assistance was a significant improvement; its unaddressed contingency showed how much improvement could still leave uncertain.