title: Hurricane Sandy: Impact on Emergency Department and Hospital Utilization by Older Adults in Lower Manhattan, New York (USA).
abstract: BACKGROUND
  On October 29th, 2012, Hurricane Sandy caused a storm surge interrupting electricity with disruption to Manhattan's (New York, USA) health care infrastructure. Beth Israel Medical Center (BIMC) was the only fully functioning major hospital in lower Manhattan during and after Hurricane Sandy. The impact on emergency department (ED) and hospital use by geriatric patients in lower Manhattan was studied.
  
  
  METHODS
  The trends of ED visits and hospitalizations in the immediate post-Sandy phase (IPS) during the actual blackout (October 29 through November 4, 2012), and the extended post-Sandy phase (EPS), when neighboring hospitals were still incapacitated (November 5, 2012 through February 10, 2013), were analyzed with baseline. The analysis was broken down by age groups (18-64, 65-79, and 80+ years old) and included the reasons for ED visits and admissions.
  
  
  RESULTS
  During the IPS, there was a significant increase in geriatric visits (from 11% to 16.5% in the 65-79 age group, and from 6.5% to 13% in the 80+ age group) as well as in hospitalizations (from 22.7% to 25.2% in the 65-79 age group, and from 17.6% to 33.8% in the 80+ age group). However, these proportions returned to baseline during the EPS. The proportions of the categories "dialysis," "respiratory device," "social," and "syncope" in geriatric patients in ED visits were significantly higher than younger patients. The increases of the categories "medication," "dialysis," "respiratory device," and "social" represented two-thirds of absolute increase in both ED visits and admissions for the 65-79 age group, and half of the absolute increase in ED visits for the 80+ age group. The categories "social" and "respiratory device" peaked one day after the disaster, "dialysis" peaked two days after, and "medication" peaked three days after in ED visit analysis.
  
  
  CONCLUSIONS
  There was a disproportionate increase in ED visits and hospitalizations in the geriatric population compared with the younger population during the IPS. The primary factor of the disproportionate impact on the geriatric population appears to be from indirect effects of the hurricane, mainly due to the subsequent power outages, such as "dialysis," "respiratory device," and "social." Further investigation by chart review may provide more insights to better aid with future disaster preparedness.
authors.affiliation: 1Department of Medicine,Mount Sinai Beth Israel,New York,New York USA.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Gotanda
authors.affiliation: 2Division of Geriatrics,Department of Medicine,Mount Sinai Beth Israel,New York,New York USA.
authors.forename: Joyce
authors.initials: J
authors.lastname: Fogel
authors.affiliation: 4Information Technology,Lenox Hill Hospital,New York,New York USA.
authors.forename: Gregg
authors.initials: G
authors.lastname: Husk
authors.affiliation: 2Division of Geriatrics,Department of Medicine,Mount Sinai Beth Israel,New York,New York USA.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Levine
authors.affiliation: 2Division of Geriatrics,Department of Medicine,Mount Sinai Beth Israel,New York,New York USA.
authors.forename: Monte
authors.initials: M
authors.lastname: Peterson
authors.affiliation: 1Department of Medicine,Mount Sinai Beth Israel,New York,New York USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Baumlin
authors.affiliation: 1Department of Medicine,Mount Sinai Beth Israel,New York,New York USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Habboushe
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055867:Cyclonic Storms / Q000706:statistics & numerical data*; D004189:Disaster Planning; D004636:Emergency Service, Hospital / Q000639:trends*; D005853:Geriatrics; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008875:Middle Aged; D009518:New York; D012189:Retrospective Studies; D055815:Young Adult
keywords: BIMC Beth Israel Medical Center; ED emergency department; EPS extended post-Sandy phase; IPS immediate post-Sandy phase; PreS pre-Sandy phase; disaster planning; geriatrics; public health