title: Prehospital Indicators for Disaster Preparedness and Response: New York City Emergency Medical Services in Hurricane Sandy.
abstract: We aimed to evaluate emergency medical services (EMS) data as disaster metrics and to assess stress in surrounding hospitals and a municipal network after the closure of Bellevue Hospital during Hurricane Sandy in 2012.
  
  
  
  We retrospectively reviewed EMS activity and call types within New York City's 911 computer-assisted dispatch database from January 1, 2011, to December 31, 2013. We evaluated EMS ambulance transports to individual hospitals during Bellevue's closure and incremental recovery from urgent care capacity, to freestanding emergency department (ED) capability, freestanding ED with 911-receiving designation, and return of inpatient services.
  
  
  
  A total of 2,877,087 patient transports were available for analysis; a total of 707,593 involved Manhattan hospitals. The 911 ambulance transports disproportionately increased at the 3 closest hospitals by 63.6%, 60.7%, and 37.2%. When Bellevue closed, transports to specific hospitals increased by 45% or more for the following call types: blunt traumatic injury, drugs and alcohol, cardiac conditions, difficulty breathing, "pedestrian struck," unconsciousness, altered mental status, and emotionally disturbed persons.
  
  
  
  EMS data identified hospitals with disproportionately increased patient loads after Hurricane Sandy. Loss of Bellevue, a public, safety net medical center, produced statistically significant increases in specific types of medical and trauma transports at surrounding hospitals. Focused redeployment of human, economic, and social capital across hospital systems may be required to expedite regional health care systems recovery. (Disaster Med Public Health Preparedness. 2016;10:333-343).
authors.affiliation: 1Ronald O. Perelman Department of Emergency Medicine,NYU School of Medicine,New York,New York.
authors.forename: Silas W
authors.initials: SW
authors.lastname: Smith
authors.affiliation: 2Office of Medical Affairs,The Fire Department of the City of New York,New York,New York.
authors.forename: James
authors.initials: J
authors.lastname: Braun
authors.affiliation: 1Ronald O. Perelman Department of Emergency Medicine,NYU School of Medicine,New York,New York.
authors.forename: Ian
authors.initials: I
authors.lastname: Portelli
authors.affiliation: 1Ronald O. Perelman Department of Emergency Medicine,NYU School of Medicine,New York,New York.
authors.forename: Sidrah
authors.initials: S
authors.lastname: Malik
authors.affiliation: 2Office of Medical Affairs,The Fire Department of the City of New York,New York,New York.
authors.forename: Glenn
authors.initials: G
authors.lastname: Asaeda
authors.affiliation: 2Office of Medical Affairs,The Fire Department of the City of New York,New York,New York.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lancet
authors.affiliation: 3Department of Population Health,Division of Biostatistics,NYU School of Medicine,New York,New York.
authors.forename: Binhuan
authors.initials: B
authors.lastname: Wang
authors.affiliation: 3Department of Population Health,Division of Biostatistics,NYU School of Medicine,New York,New York.
authors.forename: Ming
authors.initials: M
authors.lastname: Hu
authors.affiliation: 4Department of Population Health,NYU School of Medicine,New York,New York.
authors.forename: David C
authors.initials: DC
authors.lastname: Lee
authors.affiliation: 2Office of Medical Affairs,The Fire Department of the City of New York,New York,New York.
authors.forename: David J
authors.initials: DJ
authors.lastname: Prezant
authors.affiliation: 1Ronald O. Perelman Department of Emergency Medicine,NYU School of Medicine,New York,New York.
authors.forename: Lewis R
authors.initials: LR
authors.lastname: Goldfrank
mesh_terms: D002959:Civil Defense / Q000592:standards / Q000706:statistics & numerical data*; D055867:Cyclonic Storms / Q000706:statistics & numerical data*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data*; D006271:Health Facility Closure / Q000706:statistics & numerical data; D006801:Humans; D009519:New York City; D012189:Retrospective Studies
keywords: Hurricane Sandy; disaster; emergency departments; emergency medical services; prehospital; warning