By Erica Cohen

Hurricane Sandy was terrifying for all involved. Hospital patients at several New York and New Jersey hospitals, however, faced a different level of fear as they were evacuated in the middle of the storm that destroyed entire towns, left millions without power for weeks, and killed several dozen.

While the New York University Langone Medical Center (NYU) evacuation garnered the most attention, more than a dozen hospitals and other health care facilities in New York and New Jersey were required to evacuate due to the storm. Mid-storm evacuations occurred at several New York City health care facilities including NYU, Bellevue Hospital Center, Coney Island Hospital, and several nursing homes.

You might ask, how could this have happened? How could these high-tech facilities have waited so long to evacuate that hundreds of vulnerable patients, including infants from the neonatal intensive care unit, were placed at risk?

NYU successfully evacuated 200 patients in the middle of the storm, which was a true miracle. But what if the evacuation had not been successful? What if patients had died or been seriously injured during transfer? The situation would not have been considered so incredible. Regardless of what happened in the past, we must look forward to ensure this situation does not happen again.

Over the past decade, many medical facilities have learned how to better prepare for natural disasters like Hurricane Sandy. For example, newer hospitals place generators on higher floors, or even on the roof, to avoid flooding. However, most older hospitals that were built before 2001, like NYU, still house their generators in flood-prone basements.

Going forward, all hospitals, particularly those in low-lying areas prone to flooding, need to be fully prepared for a disaster like Sandy. Older hospitals should consider moving their generators to a more reliable location where they will be less affected by flooding. While this may be a challenging task for some institutions, generator failure has repeatedly been one of the greatest mechanical challenges to hospitals during natural disasters. It occurred during Tropical Storm Allison in Houston, Hurricane Katrina in New Orleans, Hurricane Irene in Connecticut, and during last year's blackout in San Diego.

Unfortunately, the money to make these improvements can be difficult to come by. To make matters worse, in 2011, 40 states and the District of Columbia reduced spending on public health programs. And federal funding dropped 38% between 2005 and 2012, according to a December 2011 report issued by Trust for America's Health.

While the U.S. health care system responded well to Hurricane Sandy, money put toward these kinds of efforts must come from somewhere. There is a risk it will be taken from other important areas like tracking the occurrence of infectious diseases or handling smaller-scale crises. These smaller-scale events may actually pose more of a financial challenge because they may not qualify for federal assistance.

It is likely that the health care system will continue to be tested with more natural disasters like Hurricanes Katrina, Rita, Irene, and Sandy. With more extreme storms expected in the future, budgets will be stretched even thinner and some hospitals could be pushed beyond their limits. Proactive planning and adequate funding are essential so that institutions can learn from past mistakes and improve their responses to future disasters.