After Storm Surge Sandy devastated the East Coast last week, many healthcare leaders are looking at their own generators and hospital evacuation plans.

Flooding is the most recurrent and extensive disaster that compromises generators, circuits, fuel tanks, and fuel pumps and forces evacuation. For the generators that continue to function during an emergency, however, there still can be challenges. Do you know how long your facility can really provide safe patient care in an environment powered by an emergency generator? Sure we all have the mindset of “move everything critical into the red outlets,” but do you really know what will work and what won’t in a power failure?

If the engineering department begins to shed load to conserve fuel in order to run the generators longer, will your department be cut off from emergency power? Patient care is usually at the top of the priority list, but what about the millions of dollars and decades of important healthcare research on your campus? Organizations need to make a department-by-department list of how emergency power will be used and then modify their response plans accordingly.

Planning Tools Are Available

There are several disaster planning and response tools available to assist healthcare leaders and emergency management professionals including the Hospital Incident Command System (HICS) materials (http://www.emsa.ca.gov/HICS/default.asp).  Specifically the Facility System Status Report form HICS 251 (http://www.emsa.ca.gov/HICS/files/hics251.pdf) can assist in determining what the operational status will be for each of your systems while operating on emergency power.

This form should be populated before a disaster by each department, including medical school departments if applicable, for each respective system. After the form is finalized and represents the organization’s systems, it will in turn become a useful tool during a disaster to assist in determining what is fully functional, partially functional or not functional, allowing the organization to create an accurate incident action plan (IAP) for the response period.

Additionally, this tool can be helpful in tracking property damage and repair during the disaster period. The campus can submit it either to the federal government or the organization’s property insurance carrier as documentation. Hospitals should keep it up to date by reviewing the systems along with the emergency management program’s annual review.

The following are systems and components that could be included in your review:

Communications

• Fax
• Information technology system (E-mail/patient registration/patient records/time card system/intranet)
• Nurse call system
• Paging – public address system
• Radio equipment
• Satellite system
• Telephone system, both external and proprietary
• Cell phones if internal booster is required to acquire cell service
• Video/television/Internet/cable

Infrastructure

• Campus roadway traffic signals
• Parking lot and campus lighting
• Fire detection and suppression systems
• Food preparation equipment
• Ice machines
• Laundry/linen service equipment
• Structural components including building integrity

Patient Care

• Digital radiography system (PACS)
• CT scanner
• MRI scanner
• Sterilizers
• Dialysis machines/components
• Isolation rooms, both positive and negative
• Laboratory components
• Blood bank components
• Pharmacy components
  • Medication refrigerators
  • Medication dispensing machines

Security

• Access control systems
• Video surveillance
• Panic (duress) alarms

Utilities – External

• Sanitation systems
• Water
• Natural gas

Utilities – Internal

• Generator fuel pumps
• Air compressor
• Elevators/escalators
• Hazardous waste containment system
• Heating/ventilation and air conditioning (HVAC)
• Medical gases
• Oxygen
• Pneumatic tube system
• Steam boiler
• Sump pump
• Well water system
• Toliets
• Vacuum for patient use
• Water heaters and circulators

Test Your Emergency Operations Plan

Every healthcare organization has an emergency operation plan (EOP) and tests it with some level of exercise as required by the accreditation bodies such as:

• California Title 22
• The Joint Commission (TJC)
• Centers for Medicare & Medicaid Services (CMS)
• National Fire Protection Association (NFPA) 1600
• Det Norske Veritas (DNV)

Many drill scenarios are one dimensional and include one event that triggers the activation of a plan. Unfortunately, most disasters present us with multiple system failures, such as the hospital flooding resulting in loss of power and forcing partial to full patient evacuation. Not all exercises are created equal. We see organizations doing the bare minimum just to check the box as completed all the way up to very extensive, multi faceted evaluation of existing disaster plans.

Exercising can be very costly. How many times have we heard that we can’t hold an exercise on the night or weekend shift because it is too expensive? Unfortunately, that’s when most disasters happen. Bellevue, Coney Island and NYU Langone all evacuated their patients on off shifts. Fortunately, they did an amazing job resulting in zero deaths as a result of the evacuation. Hurricane Sandy reminds us that it is important to train and exercise on all shifts with all staff including medical staff and residents as they are often the staff who respond to the emergency.

Moving patients in an exercise is rarely approved by hospital risk managers for obvious patient safety reasons, but that shouldn’t preclude organizations from moving their own staff during an exercise. Hospitals that service special populations including prisoners, psychiatric and brain injured patients will need to have a more complex evacuation plan.  

Don’t try to test it all at once. Test different departments and resources on an ongoing basis, which will also keep disaster planning at the forefront of everyone’s mind.

Related Articles:

• Will Your Generator Hold Up During an Emergency?

• How to Maintain Security When Electricity Fails
• DRU Offers Assistance for Higher Ed Institutions Affected by Hurricane Sandy
• Joplin Tornado Assessment: Public Didn’
  t Heed Warnings

Dr. Tracy L. Buchman DHA, CHPA, CHSP is the national director of healthcare emergency management for HSS EM Solutions. She can be reached at tbuchman@hss-us.com.

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