title: Effects of the August 2003 blackout on the New York City healthcare delivery system: a lesson for disaster preparedness.
abstract: BACKGROUND
  On August 14, 2003, the United States and Canada suffered the largest power failure in history. We report the effects of this blackout on New York City's healthcare system by examining the following: 1) citywide 911 emergency medical service (EMS) calls and ambulance responses; and 2) emergency department (ED) visits and hospital admissions to one of New York City's largest hospitals.
  
  
  METHODS
  Citywide EMS calls and ambulance responses were categorized by 911 call type. Montefiore Medical Center (MMC) ED visits and hospital admissions were categorized by diagnosis and physician-reviewed for relationship to the blackout. Comparisons were made to the week pre- and postblackout.
  
  
  RESULTS
  Citywide EMS calls numbered 5,299 on August 14, 2003, and 5,021 on August 15, 2003, a 58% increase (p < .001). During the blackout, there were increases in "respiratory" (189%; p < .001), "cardiac" (68%; p = .016), and "other" (40%; p < .001) EMS call categories, but when expressed as a percent of daily totals, "cardiac" was no longer significant. The MMC-ED reflected this surge with only "respiratory" visits significantly increased (expressed as percent of daily total visits; p < .001). Respiratory device failure (mechanical ventilators, positive pressure breathing assist devices, nebulizers, and oxygen compressors) was responsible for the greatest burden (65 MMC-ED visits, with 37 admissions) as compared with 0 pre- and postblackout.
  
  
  CONCLUSIONS
  The blackout dramatically increased EMS and hospital activity, with unexpected increases resulting from respiratory device failures in community-based patients. Our findings suggest that current capacity to respond to public health emergencies could be easily overwhelmed by widespread/prolonged power failure(s). Disaster preparedness planning would be greatly enhanced if fully operational, backup power systems were mandated, not only for acute care facilities, but also for community-based patients dependent on electrically powered lifesaving devices.
authors.affiliation: Pulmonary Division, Montefiore Medical Center, New York, NY, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
authors.forename: John
authors.initials: J
authors.lastname: Clair
authors.forename: Stanislav
authors.initials: S
authors.lastname: Belyaev
authors.forename: Dawn
authors.initials: D
authors.lastname: Alleyne
authors.forename: Gisela I
authors.initials: GI
authors.lastname: Banauch
authors.forename: Michelle
authors.initials: M
authors.lastname: Davitt
authors.forename: Kathy
authors.initials: K
authors.lastname: Vandervoorts
authors.forename: Kerry J
authors.initials: KJ
authors.lastname: Kelly
authors.forename: Brian
authors.initials: B
authors.lastname: Currie
authors.forename: Gary
authors.initials: G
authors.lastname: Kalkut
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances / Q000600:supply & distribution; D002648:Child; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000458:organization & administration*; D004189:Disaster Planning / Q000458:organization & administration*; D004560:Electricity; D004632:Emergency Medical Services / Q000600:supply & distribution; D004636:Emergency Service, Hospital / Q000458:organization & administration; D004868:Equipment Failure; D005260:Female; D006786:Hospitals, Urban / Q000458:organization & administration; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D009519:New York City; D012189:Retrospective Studies; D012122:Ventilators, Mechanical