In Sandy's Aftermath, Parts of Brooklyn Facing Major Health Crises

U.S. Public Health Service Medical Assistance Teams Deployed to Brookdale Hospital

The U.S. Public Health Service (PHS) is deployed at Brookdale University Hospital and Medical Center, serving medical needs in the aftermath of Superstorm Sandy.

For the first time ever, two Rapid Deployment Force (RDF) Teams have set up operations in a hospital.

Brookdale CEO Mark Toney led the 48 hour transformation of 1½ floors of storage areas into a fully functioning medical space for more than 100 patients from storm damaged local nursing homes and Coney Island Hospital which closed due to flooding. Brookdale Hospital and this team were able to track down all but four family members who were contacted, and notified that their family members are safe at Brookdale. Family members have come to visit, and for family who live too far away, or maybe they are victims (of Hurricane Sandy) themselves and were not able to come see their family, Brookdale and the RDF set up phone calls for them.

Lieut. Mike Muni, DPI Officer for RDF Team-2 stated, “This is a perfect example of what President Obama just talked about on the news not too long ago. We have to cut the red tape to get the services where they are needed.” Brookdale Hospital contacted the state and the Health Department offering its underutilized space. The state contacted the federal government, which “which activated our team out of Washington DC.,” Muni said. “When we got here, they were literally putting the paint on the walls as we were moving in. It was ‘all hands on deck’ for the community, for Brookdale Hospital, the state, and for the federal government.” In less than two days, the storage areas on half the 6th floor and the entire 11th floor were cleared, plumbing and electricity was fully functional, and patient beds were moved in.

 “Our teams are hospitals-in-a-box, virtually,” said Captain de la Cruz, PI Officer for PHS-2 RDF. “We come with everything from doctors and nurses, to veterinarians, sanitation, engineers, administration, hospital administrative staff, public affairs, logisticians to make sure we have all the supplies we need. We go to where we are needed within 12 to 14 hours to provide services.” Each Team arrives with its own cache of supplies, including a pharmacy and is able to provide services for up to 14 days without needing to be restocked. They serve chronic and acute care needs. “We’ve served in the past everything from seniors – nursing home evacuees like we’re doing now, special needs populations, or a family – parents, children and infants. We go the gamut,” said de la Cruz. “We don’t know the population we are going to serve until we are on the ground.”

“Brookdale Hospital has been incredibly cooperative,” said de la Cruz. “They are a fantastic collaborator and partner.”

PHS-2 is one of five RDF Teams from the U.S. Department of Health and Human Services who are ready to go at a moment’s notice after a natural disaster when called upon by the Department of Health and Human Services and FEMA to go to an area of need once they have a request by the governor.

This week saw the end of a 14 day deployment for RDF-2. Cmdr. Joseph Zagame, PI Officer for incoming RDF-1 said, “We are here to provide a seamless transition from Team-2 to Team-1. Once we get the transition plan approved and vetted by the team commanders -- our staff is in route right now – then the ongoing complement will be going home.”

Zagame, who is also a licensed pharmacist, explained that the normal complement of the team is 105 personnel. Based on the need at Brookdale, RFD-2 has 76 officers; and replacement Team RDF-1 has 65 officers because of “the exceptional job they have done laying the groundwork for us to come in to provide seamless integration and continuity of care for the patients. Whatever is needed to complete the mission we will provide,” said Zagame.

In the past, RDFs have provided medical services for other hurricanes, including Gustave and Katrina. They were officers deployed in Haiti after the earthquake and in Japan after the tsunami. “We have public health officers at the Inauguration, as well,” said Muni. “Anytime there is an opportunity for something to happen, we have public health officers the behind-the-scenes. It all falls under our mission, which is to protect, promote and advance the health and safety of our nation.”

De la Cruz added, “We can set up our federal medical station pretty much anywhere, in gymnasiums, we’ve taken over convention centers – anywhere where we can guarantee the safety of the patients that we serve. We have to have basic electricity and running water so that the medical care can be provided. But, we have set up in tents before and run our own generators. This is the first time we have been able to deploy in a hospital system.”

As hospital CEO, Toney explained his role in providing services to the greater community during a time of crisis. “When a community has been impacted the way this community has been, and Brookdale is a facility that had minimal damage to it, we have a commitment and a responsibility to take care of the people,” he said. “We need to be able to be the beacon in the community. We were able to do that.”

The entire Brookdale Hospital family pulled together.  “It was done within 48 hours. And, it was done because the Brookdale family employees here knew the need and wanted to help their neighbors,” Toney said. “Being able to offer our availability was something that we were happy to do.”

According to Toney, Brookdale staff were willing to step forward and assist the RDF Teams and throughout the hospital. Toney admitted that in today’s healthcare environment, most institutions run very lean. “We did not have access staff,” he said. “What we did is implement a state-of-emergency. All our staff are basically on-call and have to be available. We are in the business of taking care of people who need our help.” The staff stayed through the nights, and Brookdale provided bedding and food for them. “At the end of the day,” said Toney, “our staff are the ones who worked through it” even though some staff experienced flooding at their own homes. Toney said, “The hospital is running some overtime, obviously, but our staff are willing to do that because it’s needed for the patients.” In addition, Brookdale hired and is hiring more temporary staff, through the unions and the marketplace.

The nursing home patients were in the dark and the cold for an extended period of time in a couple of the facilities. “As the nursing homes start re-opening pending approval from the state, the residents on the sixth and eleventh floors will probably go back to long term care facilities versus being in an acute care hospital,” said Toney. “We hope that Brookdale will always be here as a beacon to help in a crisis.” While the RDF Teams were attending to the medical needs of their transfer patients, Brookdale Hospital is providing continuing post-Superstorm care to the greater community.  

Elliot Bondy, Director of Pulmonary Medicine at Brookdale Hospital spoke to Our Time Press about health risks in the aftermath of Sandy.

Dr. Bondy: “Exposure to mold for those people who are sensitive can cause them to have coughing, wheezing, and with a long enough exposure over a long enough period of time will start to get shortness of breath.  Usually a person who has a pre-existing pulmonary condition, for example asthma, or allergies, will have quicker symptoms. There are some people who are very sensitive to mold after a day or two will start experiencing shortness of breath and coughing. Treatment for mold exposure is removal of the mold or removal of your exposure by leaving the area. People who may have experienced sustained damage from the storm – flooded basements, wet walls, areas where mold can grow – they are going to be at risk for having mold exposure. There is nothing a person can take to prevent symptoms of mold exposure. Some people who may have been exposed might need anti-inflammatory agents. It is a little bit too early to expect to see large numbers of mold exposure cases.”

Dust is another factor when people are cleaning out their flooded homes. “People, especially cleanup workers, have to take extra precautions,” said Dr. Bondy. “Though not as serious as after 9/11, the dust in the air can contribute to airway sensitivity.”

Dr. Bondy said tuberculosis is only a risk when there is a breakdown in health standards in areas of crowding and if there is a patient who has tuberculosis in a shelter and doesn’t tell anybody. Then others are at risk, but the health department is very meticulous about following people who have tuberculosis.”

For people who live in high rises where water systems stopped functioning, the smell of human waste is not a health problem. Dr. Bondy did say that the only serious problem is physical touching of the accumulated waste. “That is an infectious disease concern,” Dr. Bondy said. The Centers for Disease Control recommends using clean bottled water for washing hands and body. 

Originally published in Our Time Press, November 15, 2012.