As flooding consumed the insides of two New York hospitals during Superstorm Sandy, knocking out power and even generators, staff hurriedly evacuated their patients.
When a Howard County wastewater treatment plant lost electricity during the October storm, causing 19.5 million gallons of diluted sewage to leak, officials hurriedly notified Baltimore Gas & Electric, Howard County Executive Ken Ulman said.
While officials hope situations such as these don't occur, they recognize that some things are simply beyond their control. And this recognition leads critical infrastructures - those hospitals and 911 radio dispatch centers and jails society relies upon - to craft plans to ensure they remain operational under the worst of conditions.
These emergency plans are dictated in employee handbooks and reiterated at training sessions, practiced during staged exercises or real-life situations.
And the majority of critical facilities have a stringent protocol in place - just in case of emergency.
Carroll County wastewater treatment plants
There are four wastewater treatment plants under the county's jurisdiction, and the generator for each is monitored closely during weather-related emergencies.
If there's a loss of electricity, the generators automatically turn on, according to Joe Barrington, Carroll County's Bureau of Utilities chief.
Filled to capacity, the plant's generators can last anywhere between two and seven days, depending on the facility's size, before they need to be refueled, Barrington said.
"As long as fuel can be hauled in, then we're in good shape," he said.
And there's several different ways the plants could acquire fuel. The county has some stored in an off-site storage facility, and there's also contractors and back-up contractors as a resource for the county wastewater treatment plants.
When Howard County's Little Patuxent Water Reclamation Plant two electrical feeders failed within three hours of each during Superstorm Sandy, the plant went without power for 12 hours.
A total of 19.5 million gallons of sewage spilled during the outage, but it wasn't a health threat because it had become so diluted, Ulman, the county's executive, said.
"Wastewater treatment plants use a tremendous amount of power," he said. "Millions of gallons of water go through there every hour, and it is very power intensive."
In order for a sewage leakage to occur in Carroll County, the volume of water coming through the pipes into the plant would have to be so vast that the tanks become too full, according to Barrington. This, coupled with the plant itself flooding, could lead to an incident.
"It's not so much that you need a big event," he said, "you just need a lot of rain in a small period of time."
While there are many municipal-run wastewater treatment plants around the county, Barrington said it would take more than a 100-year flood to cause the county's plants to overflow.
The four county-run plants are located near South Carroll High School in Winfield, Runnymede School in Mayberry, one in Pleasant Valley off of Halter Road and the largest in Hampstead off of North Woods Trail.
If a plant is located at the bottom of a watershed, it's more prone to flooding.
"Every 50 years or 100 years, you're going to get a storm that's going to be enough that's going to cause you problems," Barrington said, "and there's nothing you can do with it."
Employees learn how to handle incidents through dealing with small storms in the spring and the summer, Barrington said.
"We don't do a lot of specialized training," Barrington said. "They just get experience seeing how the different rain events affect our plant."
Springfield Hospital Center
Springfield Hospital Center tests its generators, located in all clinical areas, every month. It has a 96-hour food supply on tap every day.
Sykesville psychiatric hospital holds annual emergency training sessions for its roughly 800 employees.
All year long, the hospital is in a constant state of readiness, said Reed Correll, the hospital's environmental safety and emergency management director.
As ominous weather conditions loom or other such disasters strike, the hospital creates an internal incident command center comprised of several different trained employees. They work around the clock to ensure all necessary spots in the hospital have power, its 235 patients are being taken care of and communicate with state and local agencies, according to Correll.
Cots and linens will be rolled out for employees who decide to weather the storm inside the hospital. Some stay to ensure that they won't miss work, as hospital officials are considered "essential employees" and must be present during poor weather conditions, Correll said.
During Superstorm Sandy, this protocol was tested. Four hospital officials manned the incident command center.
A tree tumbled down atop wires, causing part of the hospital to run on a generator for four hours.
Afterward, the employees wrote an after-action report. It is one they - along with many other agencies - craft after every emergency event or training exercise to help them identify and rectify any shortcomings.
"This is a continuing cycle that we do every year," Correll said.
Carroll Hospital Center
Carroll Hospital Center operates similarly to Springfield Hospital Center.
In the event of an emergency or a planned evacuation, an internal incident command center is activated, according to Stephanie Reed, the hospital's vice president of quality and chief nursing officer.
The command center team monitors the event. They're continually in contact with state and local agencies. And essential employees know they must stay until a staff member comes to relieve them.
"Every time you have an event you learn something that helps you be better next time," Reed said.
Yet, the hospital is also constantly prepped for an emergency.
A certain amount of food and bottled water is on tap. Employees take an annual web-based course on emergency scenarios. Three generators - one in a parking lot and two on a lower level - are consistently filled to capacity, according to Tom Jeffers, emergency management and environmental safety manager.
The Joint Commission, a nationwide health-care accreditation organization, requires hospitals activate their incident command centers no less than twice a year - whether in drills or real life situations, Jeffers said.
This year the hospital participated in both: two exercises and two weather-related activations.
It was involved in a National Disaster Medical System's exercises with other hospitals nationwide; the fake scenario revolved around an earthquake and a tornado decimating the Midwest, requiring a mass evacuation.
The hospital also participated in a countywide, multi-agency drill involving a fake shooter at Carroll Community College in September.
Additionally, the hospital's internal command center was working after a fast-moving series of storms, called a derecho, slammed Maryland in June and during Superstorm Sandy.
Carroll County Detention Center
Carroll County Detention Center officials have one less thing to worry about when winds begin to screech during a hurricane or a tornado's cyclone rips through the area.
"It'd be hard to find a safer place above ground," Warden George R. Hardinger said. "The way the detention center is built is it's all cement and reinforced. Our doors aren't going to blow off."
And its generator works differently than others.
"Our generator is large enough, and it's a bit unique, that it will turn on this entire building," he said. "Every light, every outlet, the freezer, and that's unusual. And that's a good thing."
The facility always has about 30 days of food on tap. In a worst-case scenario, the detention center could provide food and shelter to emergency responders, such as police officers and firefighters, according to Hardinger.
Its staff know that they are essential personnel and must stay during an emergency until their replacement arrives. Center officials with four-wheel drive will sometimes drive to correctional officers' and nurses' homes to pick them up, he said.
There's a worst case scenario: evacuating the building's typically about 200 occupants.
This could occur if there's toxic fumes inside, a gas leak or a fire.
But there's a plan for that. The Carroll County Farm Museum or a neighboring school could be spots for a short term evacuation. The detention center has an agreement with Frederick and Howard County that inmates can be transferred to those jails for longer term evacuations and vice versa, according to Hardinger.
"A lot of it is understanding that you're going to have to improvise," he said, "and you're going to have to make due with what you have."
The Northern Landfill
Officials work to ensure that the trash and leachate - rainwater that runs through garbage - do not contaminate the environment during a weather-related event, according to Jeff Topper, the county's deputy director of public works.
Trash is buried. The leachate is collected and hauled to local septic facilities, Topper said.
Many people don't necessarily think about how a hurricane could harm a landfill, but it can, he said.
"We make sure we have the area prepared and ready to make sure we can handle the brush and debris that's going to come after," Topper said.
911 Radio Dispatch Center
It's imperative that a resident never have a problem getting in touch with 911, according to Scott Campbell, Office of Public Safety administrator.
The 911 Radio Dispatch Center handles the dispatches for all fire, rescue and emergency medical services, all Carroll County Sheriff's and Hampstead and Manchester Police Department's calls, Campbell said.
It transfers calls it receives that Westminster Police Department and Maryland State Police would handle. Maryland State Police handle calls for Taneytown and Sykesville police departments as well.
Because a call could come in at any moment, the county has several measures in place to ensure the center's services are never interrupted. It's constantly prepared for an emergency that could affect its infrastructure because, well, "some things can happen almost instantly with no warning whatsoever," Campbell said.
If the power fails, the 911 Radio Dispatch Center's generators will automatically turn on. There's an uninterrupted power supply for the generators, Campbell said, because different sources fuel them.
The center also has mobile generators it could bring in if the original ones fail, according to Campbell. And it can also relocated to its back-up facility if need be - which Campbell cannot recall having to do during his eight years in the position.
There's one more final measure that can be taken if need be. The county can remotely redirect its 911 phone calls to a neighboring jurisdiction's 911 Radio Dispatch Center as a last resort.
"We're not going to allow an interruption to occur," he said.