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ASHE study offers guidelines for emergency power resiliency


May 11, 2017

Monograph urges hospitals to turn to technology, study successes of other facilities to prepare for outages

Hospitals are beginning to take advantage of technological advances to prepare for utility outages in the wake of hurricanes and other disasters, as well as to meet more stringent code standards, but they still have a lot of work to do to take care of basic preparations.

That’s the consensus of a new white paper released by the American Society for Healthcare Engineering (ASHE) studying the effects, the aftermath, and most importantly, the responses of hospitals to stay operational in the wake of natural disasters such as Hurricane Katrina in New Orleans, Hurricane Sandy in the New York area, and most recently Hurricane Matthew in South Carolina.

During those three events, hospitals in the U.S. were faced with perhaps some of the greatest challenges in history to not only stay open, but also stay operational to help patients in the community. Those lessons don’t come easy, as was evidenced when Katrina hit New Orleans in 2005 with record flooding, plunging 80% of the city underwater and leaving hospitals without power and unable to evacuate even their most critical patients. Then came Sandy in October 2012, which hit the New York and New Jersey area with such fury that basement generators were flooded, knocking out emergency power and forcing hospitals to turn to evacuation plans they never thought they’d need. ASHE noted, however, that hospitals had learned some lessons from Katrina in preparing for Sandy, and carried out evacuation plans ahead of the storm.

“In many hospitals and nursing homes, emergency power systems functioned as intended, allowing facilities to remain open to care for their most critical patients, or to serve as a refuge for patients displaced from other hospitals and nursing homes,” the report said. “Greater-than-expected flooding contributed to the loss or pre-emptive shutdown of emergency power at six hospitals in New York and New Jersey; two had previously evacuated patients. For the four hospitals with patients when emergency power was lost, sizeable evacuations of patients occurred. No fatalities or serious injuries resulted from these evacuations, which is a credit to the extensive pre-planning hospitals undertook to prepare for potential evacuations.”

“Major storms and natural disasters such as Hurricane Katrina and Hurricane Sandy have intensified the national dialogue on emergency power for critical health care systems,” wrote the authors in the ASHE monograph, Roadmap to Resiliency. Check out the entire document at www.ashe.org/management_monographs/pdfs/mg2017cote_flannery.pdf.

“Health care facilities, emergency preparedness experts, and regulators have used these lessons learned to improve the resiliency of emergency power systems,” continued the monograph. “However, more needs to be done to heed the lessons learned given the loss of emergency power during Hurricane Sandy from the same threats that disabled emergency power during Hurricane Katrina seven years earlier. Hurricane Matthew in 2016 brought new potential challenges to light, requiring new solutions as different lessons were presented.”

In other words, don’t wait until the storm is heading your way to begin figuring out your backup plans for power generation; the time to start thinking about your needs when the lights go out is now.

Code changes reflect new needs

In emergency planning, most of today’s preparation is a direct result of the mistakes that were made during yesterday’s disasters. That certainly was the case during hurricanes Sandy and Matthew.

Some of the crucial lessons that monograph authors Eric Cote and Jonathan Flannery said hospitals need to learn from previous incidents of catastrophic utility failure include the following:

  • Flooding of emergency power system components is a chief culprit in emergency power system failures during hurricanes
  • Insufficient pre-disaster coordination with generator service and fuel providers can result in service delays at a time when it is most needed
  • Failure to inventory critical spare parts for emergency power systems can result in lengthy delays in the restoration of emergency power

The ASHE document references changes that accreditation agencies made to preparation standards in late 2016 as things that facilities should be paying attention to when crafting their preparations for the future.

For instance, in late 2016, CMS passed emergency preparedness requirements for 17 types of healthcare facilities that receive government benefits. Among other things, CMS now requires hospitals to plan to stay operational for 96 hours after a major event—and that requires the hospitals to prove that their backup power systems can remain operational.

Additionally, in July 2016, CMS officially adopted the 2012 edition of the National Fire Protection Association (NFPA)’s Life Safety Code® (LSC), a long-awaited move considered monumental by most hospital security and life safety experts as it brought up to date many standards that had been in place since 2003, when CMS adopted the 2000 edition. The new rule also included provisions of the NFPA’s 2012 edition of the Health Care Facilities Code.

One of the crucial things to keep in mind about the new regulations, ASHE said, is that while CMS in its new emergency preparedness rules dropped much-debated requirements that hospitals conduct a four-hour full-load generator test every three years, and another proposal that generators be located at higher and newer flood plain levels, that doesn’t mean these things shouldn’t be done. In addition, section 7.2.3 of the 2010 edition of NFPA 110 states that “the rooms, shelters, or separate buildings housing Level 1 or Level 2 emergency power supply system (EPSS) equipment shall be designed and located to minimize the damage from ?ooding, including that caused by the following:

  • Flooding resulting from firefighting
  • Sewer water backup
  • Similar disasters or occurrences”

The takeaway for facilities is that even though the regulations don’t say you need to test the generators or keep them above ground, the onus is still on you to prove that you are ready to deal with the unexpected.

“Questions have been raised as to why NFPA 110 simply doesn’t prohibit the generator and essential emergency power system components from being located anywhere in a flood-prone zone or area of the structure,” says the ASHE report. “Some buildings or properties cannot accommodate this measure without alternate risks, such as fuel storage within or above occupied areas, which may be why NFPA 110 language on this matter is a performance metric rather than a mandatory requirement. The burden is placed on a facility designer and owner to determine how to best protect the generator and related components from flooding hazards.”

In other words, assess your facility and its grounds now, especially since outdated and unexpected circumstances—and old and untested equipment—are exactly what led to knocked-out power at many of the hospitals that failed during Katrina, Sandy, and Matthew.

Consider the following experiences of hurricane-struck hospitals:

Bellevue Hospital in New York City—Routine evacuation and pre-storm plans worked fine. In addition, the hospital had a new electric power plant and emergency generator well above ground level on the 13th floor. However, emergency fuel stores and elevator electrical systems were located in the basement, and when a submarine door meant to protect the basement failed, floodwaters from Hurricane Sandy surged in and led to the failure of these systems.

“All utilities and services in the basement were lost, including electrical power, steam, communications, HVAC equipment, IT, computers, fire protection, systems, and elevators. Mechanical systems lost or damaged included pumps, electrical switchgear, and a combined domestic water and ?re pump system,” the report said.

While the hospital did need to be evacuated, fuel stores and generators above ground allowed contingency plans to go into effect. Specifically, the New York police brought a tanker truck in to provide emergency refueling, and hospital staff carried emergency fuel up 13 flights of stairs.

Hoboken (New Jersey) University Medical Center—While evacuating critical patients to nearby hospitals during Hurricane Sandy, a hastily executed emergency plan tried to keep the facility open, with staff installing plywood over doors, sandbagging walls, and covering low-level openings to keep out floodwaters. Two above-ground emergency generators consumed fuel from 2,000-gallon fuel tanks, which were also located above ground.

However, the hospital’s switchgear, meant to switch over to emergency power, was at a lower elevation and subject to flooding, so the hospital had to turn it off to minimize damage. As a result, while the fuel tanks, pumps, and generators were fine, the hospital still lost power, and two of its eight elevators were flooded. The event required hospital officials to relocate the switchgear equipment to higher levels in the hospital.

Southeastern Regional Medical Center, Lumberton, North Carolina—During Hurricane Matthew in 2016, while most hospitals evacuated in preparation for the storm, this facility suffered the failure of one of its five generators, which placed the hospital’s full emergency power requirements on the four remaining units. The local utility couldn’t provide an estimated time of restoration given the extensive damage to utility infrastructure, and the hospital was able to request deployment of temporary generators from the state of North Carolina and FEMA, underscoring the importance of establishing relationships with outside suppliers before disaster strikes.

Best practices

If you’re a facility concerned with staying on top of codes and regulations, and trying to make sure your hospital is ready to stay operational and keep the power on during an emergency, where do you start?

ASHE says you start with a good assessment of where you are now. Specifically, it suggests starting with an emergency power supply system vulnerability assessment survey available from the California Hospital Association (www.poweredforpatients.org/assessmentsurvey). Among the questions you should address are the following:

  • In addition to conducting required testing on backup generators, do you routinely test switchgear equipment?
  • Do you have a service contract for your emergency power system?
  • Who are your primary and secondary service and fuel providers?
  • Have you identified locations for temporary generator installations on your campus?
  • Does the hospital have a stock of recommended spare parts for the diesel generator or assurances from local diesel distributor to provide spare parts?
  • Have appropriate personnel been trained on manual operation of the diesel generators or emergency system?
  • Does your emergency generator system have any unique cooling or operational requirements that may require special measures during a disaster (heat exchangers, cooling towers, etc.)?
  • Do you have a protocol for detaching and reattaching to your electric utility during power outages?
  • Does your hospital plan to replace some or all of its generators within the next three to five years?
  • Are there restrictions in place with respect to which service companies are authorized to provide service to any of your generators, switchgear equipment, or automatic transfer switches?
  • Is your water system dependent on power for water pressure because of building elevation?
  • Is your wastewater system dependent on power for sewage flow away from your facility into local sewer or septic systems?
  • Are your generator and its components, including fuel tanks, above the flood plain and safe from other water surges such as dam and water tower breaks? If not, are system components encapsulated and protected from a flood?
  • Approximately how many years old are your generators?

“Opportunities are presented that would allow hospitals to island from the grid through innovative power generating technologies that provide the added benefit of covering more of a hospital’s critical functions on emergency power,” said the ASHE report. “As hospitals embrace these new technologies and innovative protocols, they can better protect patients and more fully serve the communities that depend on them during disasters.” These new technologies include co-generation, microgrids, and distributed generation.


How to minimize emergency risks

To minimize risks, ASHE recommends that hospitals consider taking the following actions:

Deploy and test flood mitigation technology to protect all components of an emergency power supply system, including generators, fuel sources, fuel pumps, and automatic transfer switches.

  • Coordinate before disasters with local emergency management officials to help arrange expedited government support for generator service and fuel providers, which may involve government assistance in gaining access to a disaster-affected facility when access is impeded by natural hazards or police roadblocks.
  • Identify critical spare parts for emergency power supply systems during “blue sky” days and ensure ready access to these parts during a disaster.
  • Register the emergency power supply system with the Federal Emergency Management Agency (FEMA)/U.S. Army Corps of Engineers (USACE)’s online Emergency Power Facility Assessment Tool, which can reduce the time needed by FEMA/USACE to deploy temporary generators to a facility during a disaster.
  • Adopt protocols to provide an early warning to local emergency management and/or public health preparedness officials when a hospital requires emergency power system service or refueling during a disaster. This warning can be provided through remote monitoring and automated reporting technologies or through manual early noti?cation via phone, text, or email.
  • Explore advanced power-generation technologies such as combined heat power and microgrids to reduce reliance on the grid and bolster backup power capabilities.
  • Embrace advanced technologies supporting traditional diesel-powered emergency power systems, such as dual automatic transfer switches that allow preventive maintenance without disabling emergency power.

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