When superstorm Sandy slammed into New York and New Jersey, it tested the emergency preparedness of hospitals housing some of the region's most vulnerable residents.
Despite all the hospitals' preparations, the storm's high winds and flooding forced a handful of hospitals in New York and New Jersey to evacuate all patients, including those that were in critical condition.
In New York City, NYU Langone Medical Center was forced to evacuate 300 patients after losing power in the historic storm. Among the evacuees were roughly 45 critical care patients and 20 babies, who were carefully carried down dark stairways as the 18-story hospital's elevators stood still.
A long line of ambulances lit up the dark streets surrounding the midtown Manhattan medical center, which spans four blocks along the East River, waiting to transport patients to other facilities amid gusts of wind that topped 70 miles per hour.
News of the "total evacuation" came roughly 12 hours after hospital officials said Monday morning that their emergency preparedness plan had been activated and that there were "no plans to evacuate" at the time.
But Sandy spawned record-breaking tides around lower Manhattan when it made landfall as a post-tropical storm just south of Atlantic City. The flooding prompted power outages from East 39th Street to the lower tip of Manhattan.
NYU Langone Medical Center is located at East 33rd Street on 1st Avenue. The 50-year-old building sits at sea level atop an extended bulkhead in Kips Bay.
The hospital had at least two backup generators: one in the basement and one on the roof, according to a spokeswoman. But basement flooding caused one generator to fail, and cut off the fuel supply to the other.
"We've had significant challenges at many of our hospitals and health care facilities," Mayor Michael Bloomberg said in a press conference, adding that the city health department is sending people to hospitals and chronic care facilities in the worst flood zones.
Bellevue Hospital also lost power Monday night after its back-up electricity generators failed, but Bellevue was able to get its power back up and running, Bloomberg said.
Bellevue has since completed a "partial evacuation," according to city health department spokeswoman Jean Weinberg.
Coney Island Hospital was also evacuated today, adding to the list of hospitals already emptied of patients ahead of the storm.
Not far away from New York City, Hackensack University Medical Center started receiving patients from Palisades Medical Center, whose back-up generator also failed, at 6 a.m. Although the Palisades generator was restored, conditions were too unstable to restore uninterrupted power, hospital spokeswoman Nancy Radner said. The National Guard was on hand to help transport patients.
"They were struck a bad blow, and they really needed help," said Dr. Joseph Feldman, chairman of emergency services at Hackensack University Medical Center. "So today we've taken about 23 patients already, and I see another caravan of patients are arriving in our ambulance bay."
Patients arrived with nurses from Palisades and packets of information about their medication and other health needs, he said.
"We have more than enough information to work with," Feldman said.
Hackensack is expecting 10 patients on a ventilator or in critical condition, Radner said.
"To transport even one patient in critical condition, who may be on a ventilator with multiple IV drips running on electric pumps, is a major endeavor often requiring three or more medical professionals," said Dr. Jennifer Ashton, Senior Medical Contributor to ABC News.
Although the patients have been successfully relocated, the NYU Langone website, email and phone lines remain down today.
"It surprises me that NYU could be knocked out by water in the basement," said ABC News chief health and medical editor Dr. Richard Besser. "You expect that, with a flood, water will go to the basement, so you can't put all your backup power there."
All accredited U.S. hospitals are required to have backup generators in the event of a power failure, according to Ron Dziedzicki chief support service officer for UH Case Medical Center in Cleveland, Ohio.
"We have 17 generators and four fuel tanks… The maximum amount of time we've run on generators is 72 hours without a refuel," said Dziedzicki, describing how the generators are raised to prevent flooding from nearby Lake Erie and dispersed across the 35-acre campus.
As Sandy moves inland, Dziedzicki is bracing for possible power outages. But he said he's prepared, thanks to monthly maintenance checks.
"You never know when weather's going to come," he said, describing the regular drill of switching over to backup power for an hour and keeping diesel fuel tanks topped up. If an outage were to outlast the stored fuel, UH Case Medical Center has a "memorandum of understanding" with a fuel supplier.
But even if the backup generators are working properly, the switch over can cause a 10-second lapse in power to lifesaving equipment like ventilators and bypass machines, according to Dziedzicki. At UH Case Medical Center, they have it down to five seconds, he added.
It's unclear whether NYU had additional generators and fuel storage tanks that were unable to meet the hospital's energy needs, which vary with the number of patients and the type of care they need. The hospital discharged roughly 600 patients Friday to "reduce [the] patient load," according to a spokeswoman. But Monday night's emergency evacuation has raised questions about the hospital's emergency planning.
"You never want to be in a situation like NYU faced last night where you have to evacuate during a storm," Besser said.