When the lights went out in Lower Manhattan as super storm Sandy passed through the city on Oct. 29, 2012, there remained just one hospital left functioning in the sea of darkness that remained south of 57th Street.

Beth Israel Hospital had realized that a weather event of this kind, if not of more intensity, would be devastating and had tied its critical systems to backup generators. And it worked. In fact, the hospital not only was able to remain open but stepped in to provide emergency and critical services as other nearby facilities were closed.

And while the foresight and execution served as an example of how to prepare for such worst case scenarios, the hospital also came away with plenty of lessons learned from what didn’t go so well. Those lessons were shared by Mark Etheridge, of professional services firm AKF Group, during the session “Hurricane Sandy: Lessons from the Last Hospital Standing in Southern Manhattan” at the ASHE PDC Summit in San Francisco.

For example, the facility learned quickly what was not on the emergency power system, including its electric auto-flush toilets, washer/sterilizer for OR tools, adequate patient room lighting, and service area lighting.

In the case of the toilets, staff had to pour 5 gallons of water down them to flush. The OR equipment was OK, since only emergency surgeries were being performed and enough supplies were in stock (a stock that would have run out, had the outage gone on longer). And as for the lighting, battery powered lanterns were placed where needed.

And while these were simple solutions, they were still solutions staff had to come up with and then execute. “It’s one more thing you have to go deal with that you shouldn’t have,” Etheridge said.

What also emerged were keys for success the next time the hospital finds itself in a similar situation, starting with a focus on staff and the influx of patients and visitors that surface after critical events. Not only were more patients on site due to the closure of other area hospitals, but with them came plenty of family and friends who otherwise had no access to power, food, etc. So setting up places to accommodate (and feed) everyone was important.

“The occupancy of the hospital was astronomical,” Etheridge said. All beds were full, and wait times in the emergency department reached eight hours.

Other items worth having around include plug strips and extension cords, as not all outlets had power. And a fuel supply for the generators, Etheridge said, is also high on the list of must-haves—he urged that if a facility has an inkling that a major event might take place, to get a fuel truck on site so there’s no waiting for it to show up afterwards.

Security cameras are another essential. When a hospital is understaffed and over-occupied, “you have to be able to keep an eye on what you have in your hospital,” he said.

And when it comes to putting the pieces together and a plan in place, Etheridge said it’s important to run through all the obvious concerns and then the little stuff, like those extension cords, to make sure operations remain seamless.

Consider: “If I have to do this and I have to go there from here, how do I do it,” Etheridge said. This process should include each service line to determine their specific needs.

“Those are things we can do to support this process,” he said.