HELL AND HIGH WATER
March 19, 2013
By James Thalman
The world didn’t come to an end in December 2012 as the long-gone Mayan timekeepers had hinted it might some 5,000 years ago, but for a big chunk of the United States it looked like it might when life along the Eastern seaboard was brought to a sudden, sodden stop by Apocalypse-sized Hurricane Sandy.
As Sandy plowed through Battery Park in New York City at about 8 p.m., Oct. 29, a 13.7-foot storm surge, pushed by 85 mph winds, pummeled seawater as high as the hem of the Statue of Liberty’s robes and put wide swaths of the Northeast coast temporarily below sea level.
Hurricane winds fanned out across 1,100 miles—the largest diameter of an Atlantic hurricane in recorded history—and led emergency services responders on a weeks-long wild goose chase across 24 states. The storm blew apart the daily routine like a Louisville Slugger beating dirt from a throw rug and, in a not-so-fond farewell, hooked up with a lingering rainstorm that spawned sidewinding blizzards in Virginia and Tennessee and left parts of Michigan and Wisconsin flapping in the breeze.
At about 8:30 p.m., Oct. 29, power outage calls to the University of Medicine and Dentistry of New Jersey-Emergency Medical Communication System (UMDNJ-EMS) started going off like fireworks on the 4th of July. Call loads increased 30% to 45% above the norm across the Northeast and stayed there. Great swells of seawater lifted cars like so many tub toys and winds tore out old-growth trees by the roots, flinging them across power and telephone lines and generally sending anything not made of concrete or tightly attached to it someplace else.
Calls from the stranded, sinking, or suddenly sunk gave way to a flashflood of possible carbon monoxide (CO) poisoning calls due to natural gas leaks and the large number of storm victims trying to keep warm with poorly ventilated kerosene heaters and gas stoves.
By midmorning, Tony Guido, a veteran dispatcher and IAED certified quality assurance officer with North Shore Long Island Jewish Health System for Emergency Services (NSHS) in Syosset, N.Y., was into the 20th hour of what would be 90 hours straight inside the communication center.
“We began prepping for worst-case scenarios starting on Sunday,” Guido told The Journal during a telephone interview. “When the calls hit—and we were easily up 40% of normal right away—we had already reassigned everyone to Emergency Medical Dispatching duties. We had shut down all patient transfers and had all 110 available response vehicles staged and ready when it hit.”
Shutting down all but emergency operations is just about as rare as a monster hurricane for NSHS. It is the largest hospital-based ambulance service in the New York metropolitan area and among the largest in the country, with a catchment area of 1,700 square miles of New York City and Nassau and Suffolk Counties. It handles more than 120,000 requests for service a year.
“That kind of [call] bump is a big one for us, but we really felt on top of things and ready to handle anything,” Guido said, noting that the Medical Priority Dispatch System (MPDS) “really made handling the calls the easiest part.”
The hardest part, Guido and dispatchers from Manhattan to Goshen, N.Y., agreed, was directing response vehicles around tree-blocked or flooded roads.
“We had hiccups here and there; the power would go off and on for the first little while, but the back-up generators kept us going smoothly,” Guido said.
The agency had stowed back-up protocol cardsets in plastic bags and in a locked cabinet should power supplies to the consoles suddenly give out. “We unlocked the cabinet, but that was as far as we had to go into that back-up plan,” Guido said.
Communication center supervisors had stories about both their dispatching crews and responders matching the storm blow for blow with a joint effort to reach people. Dozens of times, emergency medical responders waded waist deep through the dire straits that a few hours earlier had been their neighborhoods.
Two NSHS hospitals are located in areas that, in heavy rains and especially in hurricanes, turn into a kind of Passaic wetlands that can muddy the routine transfer of patients among facilities. With an increase in emergency calls of around 15,000 during the first two days of Sandy, transfers were limited to neonatal/pediatric moves determined to be a matter of life and death.
“The call volume didn’t throw us because we had basically shut down all but emergency operations,” Guido said. “Coordinating calls and retriaging en route is habit around here, so we just went into overdrive mode. We never got ahead of the need, but we kept up with it for the worst part of the aftermath during the next three weeks.”
The spike in calls reporting unconscious or semi-conscious or suspected CO poisonings involved people feeling sick with flu-like signs and symptoms.
UMDNJ received more than a normal year’s worth of calls requiring Protocols 31: Unconscious/Fainting (Near) and 32: Unknown Problem (Man Down) during the first week.
A “first and worst” incident involved two simultaneous CO poisoning deaths. Despite best efforts, two school-age girls in the same bedroom in Newark died as calltakers tried in vain to glean Key Question information from a highly emotional caller. The fire department requested EMS for nearly every CO alarm call they were on “to evaluate” patients; if the firefighters got a reading on their CO meters, they called for EMS.
So-called “good intent” calls put a huge initial strain on every communication center not only because of the high call volume but, also, because of suspected poisonings that were unfounded and caller refusal for care or transport, Guido and other supervisors said.
As far as the eye couldn’t see
All of Newark, N.J., and the surrounding metropolitan area went dark at 6 p.m. on Oct. 30. Floodwaters were filling roadways and subway tunnels, shorting out the power to pretty much everything that runs on electricity.
Rescuing stranded or sinking motorists dominated emergency call traffic throughout the New York City metropolitan area. Outages lasted from three days to three weeks and many were man-made—Public Service Electric and Gas Company intentionally cut power to many of its substations along the flooding Passaic River.
UMDNJ emergency dispatcher Ryan Caiazzo, who was “unfortunately on vacation” during the peak of the storm, kept tabs mostly via cell phone by listening to Newark Fire and Port Authority Police. When the power went out, so did his Voice over Internet Protocol (VoIP) line that’s part of his home cable TV package but without battery back up.
A fellow dispatcher whose home was directly in the path of the storm stayed at Caiazzo’s place for a week to ride out the storm and work his scheduled hours. They listened to news using an iPad and RadioReference.com.
“We were in complete darkness with only the glow of the iPad and some candles listening to the terror unfold around us,” Caiazzo recalled in an e-mail to The Journal. “It truly was scary. The radio calls never stopped … water rescues, fires, carbon monoxide, traffic accidents, trapped vehicles, wires down and arcing, people on oxygen who didn’t have backup when the power went out, people stuck in elevators, etc., etc., etc. Police, fire, and EMS were completely overwhelmed despite extra staffing and all the solid preplanning.”
Cell phones operated for a few hours then went dead. Caiazzo’s 4G service went to 3G and then to 2G, 1G, and then to no data at all. Even though most of Newark’s cellular antenna sites are on top of commercial buildings, it wasn’t Sandy’s winds that took them out but the lack of back-up electrical generators to keep their batteries charged.
“Finally, there was no voice capability,” he said. “By the next morning, a city that has over 150 cellular antenna sites had virtually no cellular voice service and therefore no contact with the outside world. Landlines worked for those who still have them, but because people depend on cell phones to the exclusion of landlines and other forms of communication, it was a huge problem.”
Federal, state, and local public safety administrators as well as elected public officials began continuous and urgent public requests to dial 9-1-1 only in the event of clearly life-threatening emergencies and to use social media networks and news media for damage updates or to check on the status of family members and friends.
Dispatchers describe handling the initial call traffic as something like trying to deal poker hands by throwing playing cards in the air, and the aftermath like juggling a bowling ball, a sledgehammer, and a head of lettuce.
On Halloween, Mother Nature showed up on the doorstep of Orange County 9-1-1 in Goshen, N.Y., dressed as hell and high water.
Veteran dispatcher and supervisor Melissa Alterio was girding up to face the fourth but by far scariest hurricane of her career. Floyd, Irene, and Lee had taught Alterio what Sandy would teach every dispatcher: Hurricanes are like whiplash injuries in a car crash, with the actual concussion coming when a center is slammed by calls in the immediate aftermath.
“For a dispatcher, disaster recovery is just as stressful and busy as when the storm is passing through,” Alterio said. “I don’t think most people—the public that is—realize that. We received numerous calls for days later for flooding, power outages, generators running out of fuel, and individuals requiring oxygen. And, we spent weeks dispatching mutual aid to the more devastated areas of the state.”
Even with that self-imposed triage supposedly limiting 9-1-1 calls for situations at their worst, “[call] traffic was three times busier than I’ve ever seen, and I’ve seen a lot of bad storms,” Alterio said. “Irene was by far the most memorable storm incident I’ve experienced in my career. While our 9-1-1 team handled themselves amazingly well during Irene, it also assisted us greatly for preparation for Sandy.”
Part of that experience was the abiding concern among dispatchers that their lives outside the center were being turned as upside down as everyone else’s.
“Many of them were just as fearful as the callers we were dealing with,” Alterio said. “I think for everyone, the most difficult aspect was knowing our families and loved ones were home, and perhaps somewhat vulnerable, and not able to be there with them or reach out to them when we would have liked to.”
Sandy changed Caiazzo’s view of 9-1-1. A fight outside his apartment building the night after the storm sounded serious and lengthy enough that he dialed 9-1-1. The call could not be completed and he never got through despite numerous tries. Several hours later he received a callback asking about his “abandoned” call.
“I was, for once, on the other side of the fence, experiencing the frustration that our callers experience when they can’t get through or when the system just doesn’t work the way it should,” he said. “It was a sickening and helpless feeling that I, as a 9-1-1 dispatcher, instructor, and advocate couldn’t reach help myself; it completely changed my worldview on 9-1-1 as a system, not just a number.
“We 9-1-1 dispatchers often forget and disregard the emotional component that our callers experience when they witness an event and try to obtain help only to come up against myriad barriers that stretch from technological issues to painful, structured ‘robotic’ screening,” Caiazzo added.
The quick and sustained use of volunteers was a key reason the situation didn’t turn out a lot worse, said Jeff Pompper, executive director of emergency services and the emergency management coordinator in Salem County, N.J., which had extensive damage but not a single injury.
Was the center just well prepared or mostly lucky?
“It’s probably a lot of both,” Pompper said. “But having a coordinated and willing network of volunteers definitely helped; supplementing communications with the hundred or so tireless folks who were ready, willing, and able—and able is the key.”
Communications in the aftermath of any emergency can be a problem, Pompper and other communication center supervisors said, but it can be a train wreck on top of a big natural disaster unless emergency services are able to create their own luck by plugging into an active volunteer network, regardless of how large or small their coverage area.
“Everyone was queued up and ready to roll, but there was no point in sending them when we weren’t sure they could get there and be reasonably safe once they did,” Larry Fisher, Salem County chief of communications and 9-1-1 coordinator, told The Journal a month after the storm subsided.
Surprisingly, no injuries were being reported in the region, and even more remarkable, no serious injuries occurred as the full response and cleanup began in the aftermath, Fisher said. “So, while it was the worst storm we’d ever seen, no one being seriously hurt somehow in the biggest storm anyone has ever seen is a record event in its own right.”
Unfortunately, dispatchers rarely put personal contingency plans into place, Caiazzo said.
“While 9-1-1 centers have contingency plans for disasters and loss of communications, most 9-1-1 telecommunicators don’t have their own similar contingency plans for personal communications, meals, and accommodations if their homes are destroyed, unpowered, and inaccessible for any period of time,” Caiazzo said. “Sandy should teach us that preparation and preplanning on behalf of the communication center needs to translate down to the personal level too. If you don’t have a way to rest, have shelter, or to prepare meals, you’re not going to be very effective at work.”