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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
0.00
Pr oc essing B enc h
Blo
od
Ga
s
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
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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?
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