Health care activity in the tristate region is expected to rise as the market comes to grips with some of the uncertainties that slowed it down last year, including health care and insurance reforms, executives say. But hospitals, contractors and other stakeholders are now grappling with a new problem in the wake of Superstorm Sandy"s devastating blow to many of their facilities—how to prevent that from happening again.

While 2011's Hurricane Irene made these stakeholders rethink safety, security and emergency preparedness, Sandy has brought them back to the table to come up with something much more robust, speakers told attendees at ENR New York's "A Closer Look at the Healthcare Construction Boom" conference, held today, March 1, in Manhattan. They say that health care stakeholders are now scrutinizing upgrades and expansions planned or already under way to determine how to greatly improve protections.

Factors to be taken into account include the duration of a potential crisis; site access; and location of key equipment in the facility, including generators and IT systems, both of which are usually placed in basements, says Sharon Greenberger, New York Presbyterian Hospital senior vice president of Facilities Development and Engineering, who gave the opening keynote address.

"We can't underestimate the lessons learned from Sandy," Greenberger said. She says her hospital, like many others in the region, has experienced a surge in patients since the storm, which forced it to take measures early on such as establishing a MASH unit in its lobbies to accommodate for patient overflow.

Charles Murphy, senior vice president and general manager of Turner Construction Co.'s New York Business Unit, says Hurricane Irene was just a dress rehearsal for Sandy, which "really overwhelmed all the best planning that we had done on all our campuses."

Several speakers said that the tradition of locating mechanical, electrical and plumbing (MEP) as well as other equipment in basements may need to change or, at least be greatly modified, going forward. Sandy's waters rose to the ceilings of basements and even several feet into the first floors of some institutions.

The Harlem Hospital Center's recently completed upgrade project included installing generators on its roof instead of the basement, but it left some transfer switches in the basement, says Anita O'Brien, project executive of Harlem Hospital Center, which is part of New York City's Health and Hospitals Corp. (HHC). Even though the hospital was not flooded from Sandy, there was flooding about a block away, which is cause for concern, she says. Thus, "Harlem along with other HHC hospitals is preparing a study to see what is in the basement that is critical to the hospital," she adds.

Stephen Miller, Continuum Health Partners, planning director, says the issue is compounded by the fact that most hospitals do not have the room to put such equipment elsewhere. "What do we put in our basement? What do we put in our first floors? It's problematic," he says.

Other factors that stakeholders are studying include how to get construction materials, fuel and other supplies and equipment in and out of a site, says Dino DeFeo, AKF Group's Healthcare Division partner.

The storm is also forcing institutions to consider including redundant operation centers, such as triage units as well as dialysis and cancer treatment units for emergency care during crisis. "If your emergency department is down and you only have one, then that is a problem," DeFeo says.

Sandy has also boosted demand for electrical workers and contractors, both of which "are hard to get right now," Murphy says. Many of them are doing Sandy-related work for the Federal Emergency Management Agency instead, he adds. Some speakers said they expect this situation to last until the summer.

Sandy issues aside, several speakers said they expect a continuation of the major health care trends that have been a boon to the A/E/C industry in recent years. These include demand for upgrades to aging infrastructure to make room for the latest technology; new building for ambulatory care facilities; and upgrading or expanding emergency departments and outpatient care units.

In the tristate region, many institutions have major building plans. This includes the redevelopment of the Goldwater North Hospital, another HHC hospital in Harlem, part of which was relocated from Roosevelt Island.

Meanwhile, the Dormitory Authority of the State of New York (DASNY) plans to introduce BIM guidelines as early as this spring, says Ronald Gecsedi, DASNY chief project manager of the Construction Division. "These won't be vastly different than some of the other [BIM] guidelines, but we do need to tailor it for the clients that we serve," he says.

DASNY's largest BIM project is the $348-million Bronx Mental Health Redevelopment. Gecsedi says that the project team includes local community workers, which turned out to be a big benefit post Sandy.

"Because it employed some local workers, some of its workers could walk to work," he says. "It only lost one day of work due to the storm."