Backup generators are mechanical motors, and like most mechanical equipment, they do not do well when started up after sitting idle for long periods of time. Oil gets gunky, seals crack and dry, air fills hose lines, and, in general, the generator is a backup waiting to fail.

The backup generator needs to be run and run regularly. Where I worked during the 90's we had an emergency backup generator. Once a month, there was a simulation run. The power to the grid was cut and the generator was expected to cut in smoothly and keep the power to our central communications system.

The generator, the pump, the fuel, were all in upper, secured locations (not only from the weather, floods, but from vandals as well). We made sure that key personnel had access, if needed. We were all trained in how to trouble shoot it. There was a little battery driven generator to backup the fuel pump.

We did experience two major earthquakes, as a result of which we totally lost power from the grid, and operated without a hitch. Our radio system, our lights and computers, continued to operate with only the briefest of dim out as they switched to CPU (continuous power batteries) and then again when the generator came online.

In my opinion, it was completely unacceptable for the New York hospitals to lose power and be unable to keep their most vital systems in operation. Someone wasn't visualizing the worst case scenario.