Friday, 1/11: Bellevue Hospital and NYC Department of Health

We started off the morning on Friday the 11^th with a trip over to Bellevue Hospital, the flagship hospital of the NYC Health and Hospitals Corporation (the integrated health delivery system that serves all New Yorkers regardless of ability to pay).  Bellevue is an incredible hospital, holding the title of the oldest public hospital in the United States.  We sought out Bellevue for its commitment to serving vulnerable populations in New York and caring for a diverse patient population. We started by meeting up with Dr. Paul Testa, Dartmouth Alum and current EM attending at Bellevue, who described his journey from his home in NYC to Hanover for medical school, and then back to NYC again! Dr. Testa introduced us to Dr. Raj Gulati, who led us on a tour of the ER. Since most of Bellevue's facilities are not yet open yet after Hurricane Sandy, the ER is currently operating as a stand-alone emergency department. We felt incredibly fortunate to get the chance to tour this facility, and could not have met a kinder and more welcoming group of physicians, nurses and staff!

The tour included the ER and walk-in services area of the hospital, and we were able to get a feel for how Bellevue serves its complex patient population by posting signs in several languages, and sectioning off areas to cope with volume. The hospital has recently completed a push towards ensuring patients and providers can effectively communicate, installing translation phones in every patient and ER exam room. The staff at Bellevue emphasized the importance of patient education and has taken strong measures to ensure patients receive medical education and instructions in their native language. Dr. Gulati described how Bellevue’s ER meets the needs of patients from the homeless, to immigrants, to inmates and addresses the unique challenges of these populations. Dr. Gulati highlighted how the ER responded to Hurricane Sandy and continued to serve patients after losing power and coordinated among physicians, residents, nurses and medical students to evacuate hundreds of patients.  During the tour we got a real taste of the fast-paced life of an ER doc in a massive urban setting.

Next, Dr. Testa accompanied us across the street to the NYC Poison Control Center (part of the NYC Department of Health and Mental Hygiene), making sure to highlight the famous parts of Bellevue hospital along the way. Across the street we spoke with Dr. Silas Smith, Chair of the Disaster Committee and an Emergency Medicine Physician to learn more about emergency preparedness and how Sandy impacted the city of New York. Dr. Smith gave us an in-depth presentation on how the disaster committee made the ultimate decision to evacuate Bellevue and other hospitals during Hurricane Sandy.  We learned how NY hospitals were able to find placements for patients across New York State- no small task! He also described the populations that are at greatest risk during an evacuation including the elderly, young children, homeless, and those who are dependent on medical care.  Dr. Smith led a discussion with us exploring the challenges of evacuating an urban population, such as difficulty notifying populations without access to phone, radio or TV, language barriers, and limited access to transportation. This incredible presentation allowed us to appreciate the complex factors that go into an evacuation order, and the interconnected components that create an effective emergency preparedness plan.