• Ophthalmology Unplugged: 8 Pearls for Seeing Patients Without Power

    On Oct. 29, Hurricane Sandy made her predicted northwest turn toward the coastlines of New York and New Jersey, where it would produce an unprecedented storm surge. Over the course of the afternoon, the storm felled trees, downed power lines and flooded electric substations. By evening, the East River swept over the banks of Manhattan, flooding the Con Edison power plant located on East 14th Street and knocking out power throughout Lower Manhattan.

    These outages included the New York Eye and Ear Infirmary (NYEEI), where physicians, staff and patients were left with the daunting challenge: how do you practice ophthalmology during a power outage? The infirmary staff already had a generator available to power a single exam room in the eye hospital’s urgent care center. Resident ophthalmologists were also prepared to take turns working in teams to staff urgent care over the subsequent days without power. And because the head of the NYEEI anesthesia department had visited urgent care prior to the outages, we had already made plans for how we would deal with emergency surgeries while working on backup power.

    Of course, we all agreed that we would certainly prefer to work out other options; however, gasoline shortages and the closure of public transportation made other alternatives difficult, if not impossible. The present conditions necessitated that anesthesia, ophthalmic surgical equipment and even operating-room lights must be run on generator power alone. What follows are several insights as to how we managed to provide quality medical care in this most unprecedented situation.

    1. Quickly establish communication with your anesthesia department and operating rooms. You don’t know how soon a patient needing emergency surgery may arrive, and you want to have a plan or at least some expectations in place ahead of time.
    2. Clarify the status of other ophthalmology practices and/or residency programs in your area. You may have colleagues who can help out if necessary. Having good relationships with nearby residents and attendings, and maybe even a little good karma, can really pay off during these difficult situations. Nearby physicians with power will have their own challenges as they attempt to care for the many patients who will be directed to them from areas without electricity.
    3. Do not assume that your paging system or cell phones are working. Regularly test these devices yourself. Waiting to hear back from someone who never received your message, or feeling that you are available to a nurse or co-resident while you in fact are not, disrupts patient care and can be an unfortunate delay in emergent situations.
    4. Communicate with your co-residents. This is particularly important when coordinating care for patients with acute pathology or those who are recently postoperative and who should have been seen during the time of the power outage. During the power outages caused by Hurricane Sandy, we lost our pager and our cell services. We created a message board in urgent care so we could coordinate work schedules and communicate with one another.
    5. Speak with local pharmacies. Make sure that patients will have access to the necessary medications you may be prescribing to them. Try to stay in touch with these pharmacies in case their availability changes.
    6. Keep your equipment charged whenever possible. Take advantage of generator power if you have the opportunity to keep your equipment’s batteries fully charged. There may be no backups available once your batteries run out.
    7. Try to make sure that patients’ basic needs are taken care of as well. Ask patients if you can help direct them or their families to other services in the community, such as potable water, food or a safe place to stay.
    8. Plan for what to do when the power returns. Create a plan for when and how to take care of patients needing nonemergent but urgent surgery. At the infirmary, this included running several operating rooms over the first weekend after power was restored, in an effort to catch up on necessary ophthalmic surgeries.

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    About the authors: Travis Jenkins, MD, is a second-year ophthalmology resident at the New York Eye and Ear Infirmary. He is a native of South Carolina.