By Eric Cote, Founder, Powered for Patients
The shortage of coronavirus test kits, personal protective equipment (PPE) for healthcare workers and ventilators in the face of escalating numbers of confirmed coronavirus cases offers a painful lesson about a nation finding itself unprepared for a pandemic of historic proportions.
The current resource scarcity should compel us to look ahead and consider what other critical resources we may need in future disasters that we can already project today to be in short supply. Temporary emergency power assets are one of those resources that deserves careful attention.
FEMA and the U.S. Army Corps of Engineers (USACE) jointly manage the nation’s largest fleet of temporary generators. When authorized by a federal disaster declaration, these assets are deployed at the request of governors across the country for use in hospitals, shelters, water treatment plants, waste water treatment plants, airports and other critical infrastructure where emergency power has failed, is insufficient or not present to begin with. In addition to nearly 1,000 generators owned by FEMA, the fleet is augmented by hundreds of generators owned by large rental companies with whom FEMA has contracted.
In 2017, the sizeable FEMA/USACE fleet, in concert with its private-sector rental contingent, swung into action, addressing needs triggered initially by Hurricanes Harvey and Irma, and then when Hurricane Maria slammed into Puerto Rico with devastating force. At the peak of the Hurricane Maria response, FEMA and its private-sector rental providers deployed nearly 1,500 generators, dwarfing deployments for Hurricanes Harvey and Irma, which each triggered fewer than 50 generator deployments. The sheer number of requests in Puerto Rico, especially for smaller generators, pushed the vaunted federal fleet, including its private-rental assets, beyond its limits. Desperate requests for emergency power support from health clinics, gas stations, grocery stores and other essential facilities could not be fulfilled.
This little-noticed emergency power shortage from Hurricane Maria deserves close scrutiny, as it reminds us of the consequences of insufficient resources. Of course, a fuller examination of emergency power scarcity following Hurricane Maria should wait until the COVID-19 crisis subsides.
When that conversation does take place, it will likely be informed by today’s ventilator shortage in Italy, which has seen doctors rationing ventilators to younger patients while older patients are given comfort measures ahead of certain death. Here in the U.S., hospital ethicists and attorneys are swiftly changing standard-of-care guidelines intended to clear the way for physicians to make similar gut-wrenching decisions. We hope and pray it doesn’t come to this.
In the future, a similar debate about the allocation of limited emergency power resources in a large-scale U.S. disaster could trigger equally painful choices. Even with ample fuel, an extended power outage over a sizeable geographic portion of the country would trigger an unprecedented number of generator failures, overwhelming service providers and outstripping available spare parts, as well as the robust but not endless supply of federal temporary generators. Such a scenario would force agonizing choices, much like those being contemplated now as the coronavirus intensifies in the United States.
Hospitals with neonatal ICUs would surely be prioritized over a skilled nursing facility with a large number of elderly patients. Would officials deploy a generator to a water treatment plant that supplies drinking water to tens of thousands or a 911 call center serving that same population? What about the choice of keeping a dialysis facility powered at the expense of a prison?
Let’s hope such decisions never have to be made. But given the painful choices U.S. doctors may have to make in the next few weeks – choices that too few anticipated and thus failed to plan for – emergency power scarcity should be added to the list of topics we need to prioritize when the coronavirus crisis loosens its grip on our nation.