Hospital power outage preparation never over

Electrical power equipment designed to prevent overloaded circuitry failed in New York this summer, leading to a five-hour blackout in parts of the city on July 13, pushing Mount Sinai Hospital West into disaster-response mode.

Mount Sinai executives acted quickly, switching to alternative power coming from its several diesel-powered generators, which allowed the facility to keep its clinical areas operational as well as other vital departments such as the pharmacy, laboratories and certain elevators, said Don Boyce, vice president of emergency management for parent Mount Sinai Health System.

As a result, there was no major disruption in any of Mount Sinai West’s care delivery service lines.

While power outages are less alarming than weather-related disasters that often lead to a loss of power, they still require extensive and ongoing planning and oversight, something that hospital and system executives are learning after recent outages in other places such as Hawaii, New Jersey and suburban Seattle.

The outage near Seattle hit Valley Medical Center in Renton, Wash., hard enough that fire crews on June 26 were forced to move patients stranded on upper floors to the ground floor, while some were stranded in elevators. Valley Medical declined to comment.

In New York, though the blackout was handled with relative ease by providers and staff at Mount Sinai West on Manhattan’s West Side, the event still offered lessons for the disaster management team at the hospital and its parent. One thing learned through the experience: It’s not just medications requiring cool temperatures that are at risk of spoilage.

“We were monitoring the temperature in the refrigeration, but we were also monitoring the heat and humidity in the areas that had shelf-stable medications, because some of those medications have a threshold for heat as well,” Boyce said. “As good as we can prepare there are always opportunities for us to get better.”

That kind of strategy is what experts say is appropriate but getting harder to maintain as hospital care delves deeper into technology and the size of hospitals and systems grows.

Beth Israel Lahey Health in Boston takes an all-hazards approach to power outages, giving a lot of attention to making each hospital resilient to emergencies and toward reducing the impact of power failures. “Fifteen years ago, we used to hold our breath and hope that nothing happened, but hope is not a strategy,” said Meg Femino, senior director of emergency management at Beth Israel Deaconess Medical Center.

A team led by three project managers runs emergency planning for the system’s five hospitals. Their approach is to create redundancies within emergency power systems by interconnecting the system’s five generators to ensure a hospital maintains power even when its primary or secondary power sources fail. “If I look back 15 years ago, if an emergency generator went out on one of our buildings on the east campus that would cause a complete power failure in that whole building,” Femino said. “Five generators are all interconnected so that if one goes out another one can back-feed these buildings.”

Much of the focus now is on preparing for the likeliest causes of power disruptions, such as extreme weather events like blizzards and hurricanes, along with disasters more indicative of urban areas such as mass transit accidents and building collapses.

Femino said one of the biggest improvements in readiness has been in the training of clinical staff. Beth Israel developed a system of pre-planning for times when the main power is scheduled to go off for maintenance checks. Nurse managers from all of the system’s critical-care units will meet with emergency managers weeks in advance to discuss what devices will work and won’t work during the disruption to mitigate any potential problems that might arise during the power interruption.

In addition to having multiple generators, many systems located in urban areas are connected to two electrical power grids, which allows them to switch seamlessly when their main power source is suddenly disrupted. In recent years many providers have added automatic switching capabilities to their emergency electrical power sources, so they can sense problems within seconds and make a near seamless transition to backup power without the need for someone to do it manually.

“The evolution of emergency preparedness for healthcare has brought us to areas that we (had) never even thought of,” said Neil DeGregorio, facilities director at Deborah Heart and Lung Center, an 89-bed ambulatory facility in Brown Mills, N.J. “I see things changing daily.”

Deborah Heart and Lung experienced a power loss on the evening of July 18 that lasted nearly five hours. Backup power from its three generators allowed the center to maintain its critical clinical operations, most of its elevators and the bulk of its air conditioning system. DeGregorio said technological advances in emergency support systems allow the hospital to keep vital systems running through a power outage while maintaining patient safety systems along with some less essential functions that can affect the quality of a patient’s stay.

He said a lot of emergency planning, besides considering safety, also takes into account creature comforts for patients, such as whether the hospital will be able to continue providing hot meals or maintain television service in patient rooms.

DeGregorio said not every facility has enough capacity in its emergency generators to provide continuous air conditioning during an outage, since it is not considered an essential system such as life-support devices. But addressing such issues has become increasingly important as hospitals strive to achieve better patient satisfaction. “Comfort is really critical for a lot of healthcare patients,” DeGregorio said.

Experts say how well a hospital performs during a power outage ultimately has a lot to do with how much time and resources it invested in planning.

During Hurricane Florence last September, Central Carolina Hospital, a 137-bed acute-care facility near Raleigh, N.C., owned by LifePoint Health, experienced a series of rolling brownouts that made its main power increasingly unreliable. So the hospital decided to switch to generator power to ensure it had consistent power throughout the storm.

Central Carolina CEO Spencer Thomas said a quick inventory was conducted of what would be available and what would be needed over the next several days while the hospital was running on generators and found that the refrigeration system was not being powered. The decision was made to bring in another generator on a truck to have on standby, which was ultimately used to power the entire hospital for several days.

Thomas said such assessments play a critical part in determining a hospital’s vulnerable areas during a power outage. He said emergency planning involves evaluating how the system performs both in routine testing and maintenance as well as during the actual emergency to understand ways it can be improved.

“We’ve had situations where we had minor storms and we lost power for an hour or two, and we have used those opportunities to figure out if everything worked the way we thought it would,” Thomas said. “Often we find some little thing that we’re able to go back and correct.”