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Lessons Learned from Super Storm Sandy – The Bellevue Experience

Marjorie Bon Homme, PhD, DABCC

http://ephemeralnewyork.files.wordpress.com/2014/02/bellevuehospitalgate.jpg

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Bellevue Hospital Center

• Mission ‐ to provide the highest quality of care with dignity, cultural sensitivity and compassion; regardless of ability to pay

• founded on March 31, 1736 and is the oldest public hospital

• located on 1st Ave in the Kips Bay neighborhood of Manhattan

Bellevue Hospital as viewed from the East River circa 1880 Courtesy of Ehrman Medical Library NYU Medical Center Archives

http://www.nyc.gov/html/hhc/bellevue/html/about/history.shtml

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Bellevue From the East River

Photos by Kenneth Wilsey ‐Mar 10, 2014http://www.fema.gov/vi/media‐library/assets/images

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Bellevue from the FDR Drive 

https://www.google.com/maps

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Storm Surge from Hurricane Sandy

http://i2.cdn.turner.com/cnn/dam/assets/121029074831‐03‐sandy‐1029‐horizontal‐gallery.jpghttp://www.thetimes.co.uk/tto/multimedia/archive/00350/115572780_Sandy_350113b.jpg

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The FDR Drive, flooded by Hurricane Sandy the evening of October 29.

http://ww3.hdnux.com/photos/15/75/50/3660326/3/628x471.jpg

http://cdn.arstechnica.net/wp‐content/uploads/2012/10/NYC_FDR_drive_underwater.png

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17 million gallons of water entered Bellevue’s basement

http://www.rwjf.org/en/about‐rwjf/newsroom/features‐and‐articles/20131028‐hit‐in‐disasters.htmlhttp://www.nyc.gov/html/hhc/html/feature/sandy‐anniversary.shtml

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Water Level in BasementFuel for Back Up Generators is stored in the Basement

Video by Ashley Andujar ‐ Feb 14, 2013http://www.fema.gov/media‐library/assets/images/68283

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Back Up Generators are on the 13th Floor

http://upload.wikimedia.org/wikipedia/commons/thumb/9/95/Bellevue_cube_E27_jeh.JPG/225px‐Bellevue_cube_E27_jeh.JPG

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Help Arrives

http://www.vosizneias.com/123574/2013/02/07/manhattan‐ny‐new‐yorks‐bellevue‐hospital‐resumes‐services‐after‐sandy/

http://www.globalpost.com/photo/5724742/hurricane‐sandy‐damage‐recovery‐2012‐8

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“The Bucket Brigade”

http://www.army.mil/article/90252/N_Y__mobilizes_more_than_2_300_Guardsmen_to_battle_Hurricane_Sandy_aftermath/

http://www.nyc.gov/html/hhc/html/newsletter/201211‐hhc‐facilities‐sandy.shtml

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National Guardsmen evacuate 725 patients

http://www.nyc.gov/html/hhc/html/newsletter/201211‐hhc‐facilities‐sandy.shtml

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Objective

• To share with you some tools that helped Bellevue chemistry laboratory survive

• To get you thinking about emergency preparedness for your institution

http://simage1.sportsmansguide.com/adimgs/l/1/149489_ts.jpg

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Know Your Floor PlanClinical Chemistry Main Laboratory

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Know Your Floor PlanEmergency Power for Chemistry Area

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Know Your Floor PlanCommon North American AC Power Connectors

Size/Type Straight Blade Connector

Twist‐Lock Connector

120 volt/15 amp

NEMA 5‐15P NEMA L5‐15P

208 Volt/20 amp

NEMA 5‐20P NEMA L5‐20P

120 volt/30 amp noneNEMA L5‐30P

208 volt/15 amp

NEMA 6‐15P NEMA L6‐15P

Size/Type Straight Blade Connector

Twist‐Lock Connector

208 Volt/20 amp

NEMA 6‐20P NEMA L6‐20P

208 Volt/30 amp noneNEMA L6‐30P

125 Volt 3‐phase/30 amp none

NEMA L14‐30P

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Know Your Floor PlanUnderstand the Components Required to Produce Relevant Data

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Know Your Floor PlanRefrigeration Floor Plan

• Unit #• Temperature

• Description of Contents – Reagents/Samples

• Value of Par Volume

• Priority (1, 2, 3)

• Reliability (Y/N)

• Other – In case of emergency……….

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Know Your Floor PlanEquipment Floor Plan

39500.00

2050

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Pr oc essing B enc h

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M anual B ennc hC ent aur XP /Im m unoasay

B enc h

Sam ple M anager s

Result s Ver if ic at ion/

Release

Result s Ver if ic at ion/

Release

A DVIA / Gener al C hem ist r y

B enc h

A DVIA / Gener al C hem ist r y

B enc h

A DVIA / Ur ine B enc h

1900.001900.00

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Be Prepared to Cannibalize your Instruments

Article by John Paczkowski, Apple CEO: Don’t Fear Cannibalization, Embrace It, JANUARY 23, 2013http://allthingsd.com/20130123/apple‐ceo‐dont‐fear‐cannibalization‐embrace‐it/

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Be Prepared to Cannibalize your InstrumentsKnow Where All Sources of CLRW is

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CommunicationExternal to Clinical Staff

• Test Menu

• Blood Gas Analysis

• General Chemistry Analyzer

• Expected TAT

• How to Order

• Sample Requirements

• Patient Results

http://www.securedgenetworks.com/Portals/80068/images/Clinical‐Communications‐hospital‐wireless‐network‐810.jpg

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CommunicationInternal to Laboratory Staff

• Staffing

• Bench/Instruments

• Test Menu

• by Bench

• STAT

• Workflow

• Personal Hygiene and Safety

• Planned Timelines

• Responsible Parties

• Contact Information

• Updates

http://ec.l.thumbs.canstockphoto.com/canstock4006957.jpg

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CommunicationThe Human Factor

Photo by Jocelyn Augustino ‐ Nov 02, 2012http://www.fema.gov/media‐library/assets/images/65968

http://officesupplygeek.com/category/site‐update/

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CommunicationThe Human Factor

http://www.techiefeast.com/wp‐content/uploads/2014/02/5‐Reasons‐Why‐Your‐Social‐Media‐Strategy‐Is‐a‐Flop.jpg

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Closing Down the Lab

Close Out Remaining Samples• Document disposition of all samples• Perform testing• Send‐out the restProperly Dispose of • Samples (Urine, Serum/Plasma, etc)

• Urine w/out the presence of blood is not current considered regulated waste

• ReagentsShut down Instruments• Consider sanitizing/decontamination 

prior to shutting down• Seek advice from manufacturerTurn off, unplug all unused instruments and equipment

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Closing Down the LabStability Studies

y = 0.7287x - 0.0534R² = 0.1023

3

4

5

6

7

8

9

10

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3 4 5 6 7 8 9 10 11

Subs

eque

nt T

otal

Cal

cium

, mg/

dL

Initial Total Calcium, mg/dL

Total Calcium Stability following a Freeze-Thaw CycleFrozen after Seven Days

Data Points

Reference Range, 8 - 10 mg/dL

Regression Line

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Closing Down the LabStability Studies

y = 0.969x + 0.1196R² = 0.9125

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8

9

10

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7 8 9 10 11

Subs

eque

nt T

otal

Cal

cium

, mg/

dL

Initial Total Calcium, mg/dL

Total Calcium Stability following a Freeze-Thaw CycleFresh Frozen Sample

Data Points

Reference Range, 8 - 10 mg/dL

Regression Line

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Starting Back UpDecontaminate/Sanitize your Instruments

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Starting Back UpMethod Validation

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Starting Back UpProficiency Testing

http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=/portlets/contentViewer/show&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=proficiency_testing/surveysorders.html&_state=maximized&_pageLabel=cntvwr

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In Summary:

• Know and understand your floor plans, infrastructure and resource

• Ever changing situation, so commit to re‐evaluating every 1 – 2 hours during an emergency and then 1 – 2 times a year 

• Be prepared to cannibalize a perfectly healthy instrument

• Communication

• Internal with Medical Director and laboratory staff

• External with Clinical Staff

• Considerations for Temporary Closure of a Laboratory

• Top Three Things to Remember when Re‐Opening a Laboratory following a Disaster

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Acknowledgments

Peter Jung – Manager 

Meiling Chen – Immunoassay Supervisor 

Sofyia Postelnik – POC Supervisor

Bijan Davoudi – General Supervisor

Kathay Gayle – Immunoassay Supervisor

Alla Valtsis – QC Supervisor

Charles Blackwell – Night Supervisor

Andrew Kapsopoulos – Overnight Supervisor

The Entire Chemistry Laboratory

Dr. Maria Aguero – Medical Director

Patience Mancho – Senior Administrator

Neil Peckman – Administrator

Jacobi Hospital – Desiree Mehegan, Manager

Memorial Sloan Kettering – Dr. Kazunori Murata

Siemens – Dennis Williams, Field Service Engineer; Maggie Bruno, Account Manager

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Thank you for your attention

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Do you have any questions or comments?