Potent Storm Hits Wide Swath of U.S. and Moves East

By Wednesday afternoon, more than seven inches of snow had fallen in Indianapolis, the National Weather Service reported, and by the evening more than 18 inches covered parts of Illinois. 

Detroit, under a heavy snowstorm, declared snow emergencies in some parts of the city, according to local reports, asking cars not to park on the street to make room for snow plows. More than 1,500 flights were canceled on Wednesday, according to the Web site Flight Aware, which also listed delays of an hour to two hours at airports across the Eastern United States.

The brunt of the storm was expected to hit western New York and extend into central Maine through Thursday morning, forecasters said, an area that could get 12 to 18 inches of snow. In Buffalo, as much as two inches each hour could be falling by Thursday morning, combined with 30-mile-per-hour winds, according to the Weather Service.

In New York City, the slushy snow that fell initially gave way to heavy rain and sustained wind of up to 35 miles per hour, and gusts as high as 60 miles per hour were expected overnight, said Tim Morrin, Observation Program Leader at the National Weather Service. The heavy rain, up to 1.8 inches overnight, could lead to flooding in areas with poor drainage, Mr. Morrin said. There is a coastal flood warning in effect during high tides Wednesday and early Thursday “along the Battery, Bergen Point, the mouth of the Hudson and portions of the western Long Island Sound,” he added.

Flights into Newark and LaGuardia airports were delayed by more than two hours on Wednesday evening, and flights into John F. Kennedy International were held up for over an hour, according to the Federal Aviation Authority. The storm, Mr. Morrin said, is not due to taper off until Thursday afternoon.

In Westchester County, where some wires went down after 7 p.m. in Larchmont, 2,300 customers were without electricity on Wednesday evening, said Chris Olert, a spokesman for Con Edison.

On Tuesday, parts of the country unaccustomed to a white Christmas were hit hard by snow, including Little Rock, Ark., where nine inches fell, and parts of Oklahoma, where seven inches of snow contributed to a 21-vehicle pileup on an interstate outside Oklahoma City, the authorities said.

While that accident caused no serious injuries, a car crash in Major County, in northern Oklahoma, killed a 28-year-old woman as the vehicle she was riding in struck a tractor-trailer on a snowy highway, the Oklahoma Highway Patrol said.

Also Tuesday, a man died outside Houston when he got out of his car to remove a tree that had fallen in high winds and blocked the road. As he tried to drag the tree away, a second tree fell and crushed him, according to the Harris County sheriff’s office.

More than 200,000 people remained without power on Wednesday, many in Arkansas, where winds toppled power lines and trees.

Thirty-four tornadoes were reported from Texas to Mississippi on Tuesday, prompting Gov. Phil Bryant of Mississippi to declare a state of emergency after several counties were battered by storms, including a twister that destroyed homes in Pearl River County, said Danny Manley, the county’s emergency management director.

A tornado also rolled through downtown Mobile, Ala., causing significant damage to Murphy High School and tearing off part of the roof of Trinity Episcopal Church, according to the Mobile County Emergency Management Agency. No serious injuries were reported.

In California, two people died Monday in avalanches in the Sierra Nevada Mountains, where there was heavy snowfall over the weekend, the authorities said.

Ravi Somaiya contributed reporting.

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About New York: One Boy’s Death Moves State to Action to Prevent Others

The action by New York has elated sepsis researchers and experts, including members of a national panel who this month formally recommended that the federal government adopt standards similar to what the state is planning.

Though little known, sepsis, an abnormal and self-destructive immune response to infection or illness, is a leading cause of death in hospitals. It often progresses to severely low blood pressure, shock and organ failure.

Over the last decade, a global consortium of doctors, researchers, hospitals and advocates has developed guidelines on early identification and treatment of sepsis that it says have led to significant drops in mortality rates. But first hints of the problem, like a high pulse rate and fever, often are hard for clinicians to tell apart from routine miseries that go along with the flu or cold.

“First and foremost, they need to suspect sepsis,” Dr. Mitchell M. Levy, a professor at Brown University School of Medicine and a lead author of a paper on the latest sepsis treatment guidelines to be published simultaneously next month in the United States in a journal, Critical Care Medicine, and in Europe in Intensive Care Medicine.

“It’s the most common killer in intensive care units,” Dr. Levy said. “It kills more people than breast cancer, lung cancer and stroke combined.”

If started early enough, the treatment, which includes antibiotics and fluids, can help people escape from the drastic vortex of sepsis, according to findings by researchers working with the Surviving Sepsis Campaign, the global consortium. The tactics led to a reduction of “relative risk mortality by 40 percent,” Dr. Levy said.

Although studies of 30,000 patients show that the guidelines save lives, “the problem is that many hospitals are not adhering to them,” said Dr. Clifford S. Deutschman, director of the sepsis research program at the Perelman School of Medicine at the University of Pennsylvania and the president of the Society of Critical Care Medicine.

About 300 hospitals participate in the study, and the consortium has a goal of having 10,000. “The case is irrefutable: if you take these sepsis measures, and you build a program to help clinicians and hospitals suspect sepsis and identify it early, that will mean more people will survive,” Dr. Levy said.

At a symposium in October, the New York health commissioner, Dr. Nirav R. Shah, said that he would require state hospitals to adopt best practices for early identification and treatment of sepsis. Gov. Andrew M. Cuomo intends to make it a major initiative in 2013, said Josh Vlasto, a spokesman for the governor. “The state is taking unprecedented measures to prevent and effectively treat sepsis in health care facilities across the state and is looking at a wide range of additional measures to better protect patients,” Mr. Vlasto said.

In April, Rory Staunton, a sixth grader from Queens, died of severe septic shock after he became infected, apparently through a cut he suffered while playing basketball. The severity of his illness was not recognized when he was treated in the emergency room at NYU Langone Medical Center. He was sent home with a diagnosis of an ordinary bellyache. Hours later, alarming laboratory results became available that suggested he was critically ill, but neither he nor his family was contacted. For an About New York column in The New York Times, Rory’s parents, Ciaran and Orlaith Staunton, publicly discussed their son’s final days. Their revelations prompted doctors and hospitals across the country to seek new approaches to heading off medical errors.

In addition, Commissioner Shah in New York convened a symposium on sepsis, which included presentations from medical experts and Rory’s parents.

At the end of the meeting, Dr. Shah said that he had listened to all the statistics on the prevalence of the illness, and that one had stuck in his memory: “Twenty-five percent,” he said — the portion of the Staunton family lost to sepsis.

He said he would issue new regulations requiring hospitals to use best practices in identifying and treating sepsis, actions that, he said, he was taking “in honor of Rory Staunton.”

The governor’s spokesman, Mr. Vlasto, said that “the Staunton family’s advocacy has been essential to creating a strong public will for action.”

Dr. Levy said New York’s actions were “bold, pioneering and grounded in good scientific evidence,” adding, “The commissioner has taken the first step even before the federal government.”

Dr. Deutschman said that initiatives like those in New York were needed to overcome resistance among doctors. “You’re talking about a profession that has always prided itself on its autonomy,” he said. “They don’t like to be told that they’re wrong about something.”

The availability of proven therapies should move treatment of sepsis into a new era, experts say, comparing it to how heart attacks were handled not long ago. People arriving in emergency rooms with chest pains were basically put to bed because not much could be done for them, said Dr. Kevin J. Tracey, the president of the Feinstein Institute for Medical Research at North Shore-Long Island Jewish Health System. Dr. Tracey, a neurosurgeon, has made major discoveries about the relationship between the nervous system and the runaway immune responses of sepsis.

If physicians and nurses were trained to watch for sepsis, as they now routinely do for heart attacks, many of its most dire problems could be headed off before they got out of control, he said. The Stauntons have awakened doctors and nurses to the possibility of danger camouflaged as a stomach bug.

“We are with sepsis where we were with heart attack in the early 1980s,” Dr. Tracey said.

“If you don’t think of it as a possibility, this story can happen again and again. This case could change the world.”

E-mail: dwyer@nytimes.com

Twitter: @jimdwyernyt

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