Editor’s note: This article is part of a series on the impact of Hurricane Ida on health care facilities, the experiences of health care facilities managers in affected areas, and hurricane preparedness and response.

The David H. Koch Center for Cancer Care at Memorial Sloan Kettering Cancer Center in New York City is a health care facility built with resilience in mind. Completed in 2019, the facility faced its first major challenge earlier this year in September when Hurricane Ida reached New York and brought with it strong winds and significant amounts of rain.

The 770,000-square-foot facility is located in 100- and 500-year floodplains, and its location adjacent to the East River makes flooding the greatest threat. The facility was designed using three primary resiliency strategies: protection against water infiltration, elevation of critical infrastructure and redundancy of critical infrastructure systems.

A number of the facility’s features were designed to prevent water infiltration, including three hydraulic flood barriers on the north side — the side most prone to water overcoming Franklin D. Roosevelt East River Drive and reaching the building — and two gravity flood barriers on the south side.

“Our 25,000-gallon fuel oil storage tank located down in the in the subcellar is encased in a concrete vault,” says Eric Lorenzen, director of plant operations for Memorial Sloan Kettering Cancer Center. “Its entry point is protected by a submarine-style, flood-proof door. In the event of that we do see water coming, our flood mitigation plan is to deploy our flood barriers. We also seal that vault to make sure that nothing can happen to our fuel source.”

Critical infrastructure has also been elevated above the floodplain in order to minimize the impacts of breaching of the flood barriers. For example, the main electrical services and utility transfers and meters are located on the second floor. The boilers are on the twenty-third floor just below the roof of the 400-foot-tall facility instead of in the basement where they are typically located.

If flooding occurs and critical infrastructure systems are compromised, the built-in redundancy ensures that the facility can continue full operations. The facility would still maintain approximately 33% of its normal power requirement, and an additional 33% of the building would be powered by emergency generator.

“After Hurricane Sandy, the south side of Manhattan had no power,” Lorenzen says. “This facility was specifically designed in the event of a local area outage or a major catastrophe. Not only do we have a natural gas microturbine power plant to produce power but also to utilize the waste heat for reheating of the building’s air systems. We also have N+1 redundancy independent power generation on the emergency power side.”

While the experience of Hurricane Sandy in 2012 informed resilient design strategies for the David H. Koch Center for Cancer Care, the effects and outcomes of the two storms differed. Hurricane Sandy moved up the coast, and its approach along with the high tide resulted in devastating impacts. Hurricane Ida, on the other hand, was a slow-moving inland storm, and Lorenzen says that, while the facility and staff were prepared, no one expected the amount of water and the rapid accumulation.

“At the David H. Koch Center for Cancer Care, we had anticipated deploying our flood mitigation strategies,” Lorenzen says. “With the gross amount of water that was deposited in New York City, it was basically a 13-minute window to deploy the strategies. That’s how quickly the water rose. We were ready to act and by the time we said, ‘Go,’ the water had already begun to rise.”

Resiliency strategies are continually evolving, and the experience of Hurricane Ida has already resulted in adjustments to response protocol at the facility. “When we get a notice of flash flooding for New York City, we will take action in advance instead of waiting to see what the storm looks like,” Lorenzen says. “For example, we had a flash flood warning for a recent summer storm. We deployed our flood barrier system preemptively on a limited basis. Our thought process after Hurricane Ida was that we have the systems in place, so why wait to use them.”

A key factor from the start of the project was the ongoing collaboration that brought together the architects, engineers and operations staff, Lorenzen says. “Even now we still work with each other on a very regular basis and discuss things that work, things that don’t work, how we can make this better, and what we should take into consideration. That process is critical to success because everybody is on the same page and information trickles down to the teams who are ultimately responsible for the construction and then the operations.”

Lorenzen adds that the advantages of resiliency extend beyond preparing for and responding to disasters. Energy efficiency, operational effectiveness and commissioning components all factor into resilient design. Therefore, the involvement of the facilities staff and engagement with the engineering, design and construction teams are crucial.

As the frequency and severity of climate-related events continues to increase, planning and preparation will become even more important for health care facilities. For the David H. Koch Center for Cancer Care, resilient design has proven extremely effective in protecting the facility from both the expected and unexpected impacts.

“There’s nothing like this facility,” Lorenzen notes. “The attention to detail for resiliency can’t be overstated. During Hurricane Sandy, the previous site was completely underwater. During Hurricane Ida, there were geysers of water coming up out of the storm system at the FDR. Once we raised those barriers, the building was completely protected. It was truly amazing, and everything worked the way it was supposed to work.”

Learn More

A September 2019 HFM article looked in more detail at the resilient design strategies of the David H. Koch Center for Cancer Care.

The Sustainable and Climate Resilient Health Care Facilities Toolkit from the Department of Health and Human Services (HHS) includes resources for the construction and retrofitting of critical facilities.

Primary Protection: Enhancing Health Care Resilience for a Changing Climate is a guide and toolkit from the HHS for assessing vulnerabilities and identifying resiliency solutions, including resilient design.