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Extended Power Outages Triggered by Hurricane Ida Likely to Challenge Ability of Louisiana Hospitals and Nursing Homes to Comply with New Federal Rules Prohibiting Excessive Heat in Patient Care Areas

Powered for Patients, a 501c3 non-profit created after Hurricane Sandy to better safeguard emergency power for critical healthcare facilities, said today that the extended power outages caused by Hurricane Ida will seriously challenge the ability of Louisiana’s hospitals and nursing homes to comply with new federal rules intended to prevent dangerous overheating of patient care areas within healthcare facilities.

The CMS Emergency Preparedness Rule, first proposed in December 2013 by the Centers for Medicare and Medicaid Services (CMS) and finalized nearly three years later, requires hospitals and skilled nursing facilities to ensure that temperatures in patient care areas not exceed 81 degrees during power outages. For most facilities, meeting this rule requires connecting a portion of the facility’s air conditioning system to emergency power, an expensive step that many facilities have yet to undertake. The use of portable cooling devices can also help lower temperatures but in larger facilities, these devices will likely be insufficient to ensure that temperatures don’t rise above 81 degrees in all patient care areas.

The requirement that hospitals and nursing homes maintain temperatures at or below 81 degrees during power outages reflects the deadly lessons of past hurricanes, including Katrina and Irma, both of which triggered patient deaths due to extreme heat in patient care areas. Following Hurricane Irma, twelve elderly residents of the Hollywood Hills Rehabilitation Center in Hollywood, FL died after an extended power outage drove temperatures inside the facility to dangerous levels. These deaths triggered new laws in Florida mandating that nursing homes install generators capable of supporting air conditioning systems during power outages.   

As part of an ongoing emergency power resilience initiative being undertaken for the Los Angeles County Emergency Medical Services (EMS) Agency, Powered for Patients recently completed a census of the emergency power systems in Los Angeles County’s hospitals. The census revealed that many of the hospitals have not connected any of their air conditioning system to a source of backup power.    

“Through our work in Los Angeles County, we’ve seen first-hand that many hospitals have not yet made the investments needed to connect portions of their air conditioning system to emergency power in order to comply with the new federal requirements,” said Eric Cote, Project Director for Powered for Patients. “It is likely that many of Louisiana’s hospitals and nursing homes face this same challenge and as a result, a number of facilities will find it difficult to keep temperatures in patient care areas below the required 81 degrees given the forecast for dangerously hot and humid weather.” Facilities that cannot keep temperatures in patient care areas below 81 degrees may need to consider evacuating, a move that would pose an added challenge to facilities already straining in the aftermath of Hurricane Ida.

Before the CMS Emergency Preparedness Rule was enacted, emergency power requirements necessitated that a hospital would need enough generator power to cover approximately 33% of a its normal electrical load. Experts suggest that to fully back up a hospital’s air conditioning system on top of its other emergency power requirements, most hospitals would have to double the size of their generator fleet, a very expensive step that many hospitals have been unable to take.  

FEMA Generator Checklist Can Help Minimize Risk of Emergency Power Failures

Powered for Patients has posted a FEMA checklist of steps that should be taken when generators are operated for extended periods of time to reduce the likelihood of a generator failure.

“The likelihood of a long-term power outages represents a serious challenge and a potential threat to patient safety, but it’s important for hospital facility staff to know that there are steps they can take now to reduce the likelihood of a generator failure,” said Cote. “I encourage facilities to print the FEMA checklist and make sure it is distributed to all facility staff and adhered to closely.”

Cote also urged hospitals to notify their local emergency managers at the first sign of any threat to emergency power. “Facilities should not wait until a generator has failed to notify their local emergency manager that they are experiencing a problem with emergency power,” said Cote. “Instead, we recommend that a hospital notify their local emergency management agency at the first sign of any threat to emergency power. This can help expedite deployment of temporary generators.” FEMA announced yesterday that 200 generators have been deployed to Louisiana and more are expected in the coming days.

Aging Generators and Single Generator Hospitals Also Seen as a Potential Problem Amid Extended Power Outages

Among the findings of the recent Powered for Patients census of emergency power systems in Los Angeles County hospitals was a significant number of outdated generators. The useful life expectancy of a generator is approximately 30 years of age and the recent analysis showed that 30 percent of the generators among surveyed hospitals are older than 30 years of age, with 42 of these generators between 40 and 49 years of age and four generators older than 50 years of age.

In addition to an aging generator fleet, the recent census found that fifteen Los Angeles County acute-care hospitals rely on just a single generator, leaving these facilities, and the patients in them, with no source of redundant emergency power. Among these fifteen hospitals, 60 percent of their generators are over 30 years of age, with several generators over four years of age and two over 50 years of age.

“If our findings in Los Angeles County are representative of hospital generator fleet in Louisiana, there may be as many as 16 acute care hospitals in Louisiana operating with a single generator, many of which would be older than 30 years of age,” said Cote. “These are added risk factors that warrant close attention from state and local officials, especially as the power outage extends into days and even weeks in the worst-case scenario.”

Emergency management officials in Louisiana have been in touch with hospitals to determine their available generator fuel and the projected burn rates to help coordinate the fuel replenishment process.

Lesson from COVID-19: Resource Scarcity Puts American Lives at Risk

By Eric Cote, Founder, Powered for Patients

Since the COVID-19 pandemic began in early 2020, the initial shortage of coronavirus test kits, personal protective equipment (PPE) for healthcare workers and ventilators in the face of escalating numbers of confirmed coronavirus cases offered a painful lesson about a nation finding itself unprepared for a pandemic of historic proportions.

Today, as the number of Americans diagnosed with COVID skyrockets, hospitalizations have risen to an all-time high, triggering fears that hospitals will be pushed beyond the brink. The resource scarcity driving fears now is no longer ventilators or PPE but the staff needed to care for patients and operate ventilators as well as the physical space hospitals need to care for the sickest patients, including COVID victims and those recovering from heart attacks, strokes and other life-threatening conditions.

As efforts to address shortages of staff and hospital space advance, yet another serious threat worthy of attention looms: the heightened risk of power outages, an especially relevant menace in California where Public Safety Power Shutoffs have already been initiated to reduce the risk of wildfires.  

This risk of emergency power failures during power outages is all too real and their consequences can be deadly for patients in hospitals and nursing homes. During California’s 2019 Public Safety Power Shutoffs, two hospitals and five skilled nursing facilities experienced generator failures, and hospital emergency power failures during Hurricane Katrina were blamed for patient fatalities.

Single-generator vulnerability 

The consequences of losing emergency power during an outage are especially dangerous for patients in the estimated 950 non-rural hospitals across the U.S. that rely on a single generator. Another 1,100 critical access hospitals, with 25 beds or fewer and often located in remote areas, also rely on a single generator. Skilled nursing facilities licensed to provide ventilator care represent another significant threat. There are an estimated 1,350 such facilities in the U.S. and the overwhelming majority of them have no redundant emergency power. Making matters worse, a number of these single-generator hospitals and skilled nursing facilities rely on generators that in some cases are more than 40 years old.

The loss of emergency power in a single-generator facility caring for ventilator patients would represent a life-threatening emergency, as staff would have only a few hours of ventilator battery life before they would need to manually ventilate patients during the race to replace a failed generator or transfer patients to another facility.

The failure of emergency power in single-generator hospitals and nursing homes is not a remote threat. Powered for Patients documented two such failures during the 2020 Atlantic hurricane season, each resulting in the emergency evacuation of electricity-dependent patients.

With the record 2020 hurricane season behind us, winter weather joins Public Safety Power Shutoffs as the latest threat to utility power. The famous Kentucky Ice Storm, which struck in January 2009, produced one of the longest power outages in Kentucky history and triggered one of the largest deployments of temporary replacement generators in U.S. history.   

Reducing risk in an emergency

Thanks to a technology investment made in 2018 by the Department of Homeland Security, a new tool recently become available that can dramatically change the outcome for patients in single-generator facilities that face threats to emergency power during an outage. The P.I.O.N.E.E.R.® Tool connects to emergency power systems like a heart monitor connects to a patient and provides real-time, automated alerts anytime emergency power in a critical facility faces a threat. P.I.O.N.E.E.R. stands for Power Information Needed to Expedite Emergency Response.

P.I.O.N.E.E.R. was developed by Powered for Patients, a 501c3 non-profit that received a contract from DHS to create a tool that would provide automated alerts anytime emergency power faced a serious threat during a power outage. Automated, real-time warning of a threat to emergency power can be a game changer, especially for patients in single-generator facilities. Armed with this early warning, service providers can accelerate deployment of service teams and government agencies with temporary generators can ready these assets more quickly for deployment. In cases where utilities have the ability to restore power, early warning will accelerate the process. In worse-case scenarios, where emergency power cannot be repaired or replaced in a timely fashion and expedited power restoration is not possible, the early warning provided by P.I.O.N.E.E.R. will enable a significant head start in planning for a safer evacuation of patients.

Initial deployments of the P.I.O.N.E.E.R. Tool are planned for single-generator hospitals in Los Angeles County, a timely move given the rise in COVID hospitalizations and the recent resumption of Public Safety Power Shutoffs. An initiative to expand deployment of the P.I.O.N.E.E.R. Tool to all single-generator hospitals and skilled nursing facilities treating ventilator patients in the U.S. is detailed in the Power Resilience Blueprint, a COVID-inspired plan to address immediate and longer-term threats to emergency power in critical medical facilities. The Power Resilience Blueprint was developed by Powered for Patients and the Electric Infrastructure Security Council, another 501c3 non-profit involved in preparing the nation for the impact of long-term and widespread power outages. 

COVID patients requiring the support of ventilators to survive are already facing long odds. P.I.O.N.E.E.R. can reduce another risk facing these patients, especially those in facilities relying on a single generator.  

Powered for Patients Issues Guidance for Hospitals with Single Generator Emergency Power Systems Amid Potential Coronavirus Spike in Use of Ventilators

In response to the growing coronavirus crisis, Powered for Patients has provided guidance information to federal, state and local public health officials about the potential vulnerability of hospital emergency power systems that rely on a single generator.

Recent news reports have highlighted the potential shortage of ventilators should the scale of the outbreak reach a level where tens of thousands of Americans need respirators. An estimated 16% of U.S. hospitals use only a single generator and nearly all Skilled Nursing Facilities (SNFs), including those licensed to provide respirator care for patients, rely on a single generator. While a ventilator can be operated manually by clinicians to keep a patient alive, this is only done for short periods of time in extreme situations when utility or emergency power is not available.

Facilities relying on a single generator for emergency power support have no redundant emergency power in the event that their single generator fails. This represents an increased risk that should be considered by public health officials and those operating hospitals and SNFs with single generator emergency power systems.

“It’s important to note that with proper maintenance, single generators may have a low risk of failure,” said Powered for Patients project director Eric Cote. “Yet, the consequences of losing emergency power in a facility with a single generator are for more serious than the loss of a single generator in a facility with multiple generators.”

The Powered for Patients guidance information advises facilities currently treating or slated to receive coronavirus patients to test their emergency power system prior to receiving patients (or prior to receiving additional ventilator patients.) This suggestion reflects lessons learned in 2019 when Public Safety Power Shutoffs (PSPS) in California triggered the failures of emergency power in two hospitals and five skilled nursing facilities.

The Powered for Patients guidance material also includes information from FEMA Guidance Document P-1019 that includes a checklist of steps facility managers can take before, during and after disasters to minimize the risk of an emergency power system failure. The guidance material also includes a spare parts inventory and fuel consumption checklist that facility managers can use to stay on top of fuel supply and help ensure that sufficient generator supplies and consumables are on hand at a facility at all times.  

Powered for Patients Creates Real Time Emergency Power Threat Reporting Tool with DHS Funding and Partnership with Industry Leaders

Washington, D.C. – In addition to fatalities and serious injuries, other common casualties in Hurricanes Maria, Matthew, Sandy and Katrina were hospital emergency power systems. They suffered failures that ranged from debilitating to catastrophic, triggered by mechanical problems, extreme flooding or a lack of fuel. The partial or total loss of emergency power at numerous hospitals in Hurricanes Sandy and Matthew triggered emergency evacuations.  Generator failures following Hurricane Katrina were blamed for patient fatalities.

Today, a new effort is underway to tap a powerful yet under-leveraged technology that will provide government officials and utilities with the first-ever near real time, automated warning when emergency power is threatened at a hospital or other critical healthcare facility grappling with an extended power outage.

This early warning of a threat to emergency power will be provided through a new online tool being developed by the non-profit Powered for Patients with funding from the U.S. Department of Homeland Security, Cybersecurity and Infrastructure Security Agency (CISA), National Risk Management Center, through the National Infrastructure Protection Program Security & Resilience Challenge, which is implemented by the National Institute for Homeland Security (NIHS). The Security & Resilience Challenge program invests in promising technologies that can help government and the private sector tackle some of the more daunting challenges of disaster planning and response.

The early warning of a threat to emergency power provided by the dashboard can be a gamechanger, enabling emergency managers to accelerate deployment of government generators and generator fuel. Government transport for private generator service teams unable to navigate road closures in getting to client sites could be marshalled faster. Armed with near real time warning of a threat to emergency power at a critical facility, utilities could shift restoration priorities to restore utility power before emergency power is lost. Success by government agencies or utilities in their respective efforts to aid a stricken facility would protect patients, including some of the most vulnerable, whose ability to endure hasty evacuations is often precarious.

Mechanical fault detection and automated reporting technology is the cornerstone of the prototype developed by Powered for Patients through the DHS contract. This technology is being connected to emergency power systems in increasing numbers by hospitals, water systems, waste water treatment plants and cell tower operators across the U.S. The slightest mechanical hiccup or a low fuel level triggers an automated, real time notification via text or email, alerting facility managers and their service providers to any situation requiring immediate attention.  This technology also has advanced capabilities that can diagnose a serious problem remotely, a powerful capability for unmanned facilities like cell towers and pumping stations for water and waste water treatment systems.

Despite the growing use of this advanced technology, no hospital, water system or waste water treatment plant in the U.S. has shared this valuable data stream with government officials or utilities. The primary reason: they’ve never been asked. That’s changing thanks the Department of Homeland Security funding provided to Powered for Patients, the 501c3 non-profit created after Hurricane Sandy to better safeguard emergency power and accelerate utility power restoration for critical healthcare facilities impacted by disaster.  

Since the majority of U.S. hospitals do not use fault detection and automated reporting technology, the emergency power reporting Dashboard is being designed to receive manually submitted reports. This design feature will enable every hospital in the U.S. to use the Dashboard along with skilled nursing facilities and large dialysis centers, neither of which generally use the advanced fault detection and automated reporting technology for their emergency power systems.  

Among the challenges vexing emergency responders and public health preparedness officials has been limited situational awareness about the status of back-up power at hospitals and other critical infrastructure. In past incidents where hospital emergency power has been threatened, communications from impacted facilities to government officials and utilities seeking assistance has been disjointed and oftentimes delayed.  Rarely has a notification of a threat to emergency power been provided at the first sign of trouble, a reality that deprives government officials and utilities of a head start that could make the difference between hospitals having to evacuate or not.

Technology Company Competitors Join Forces to Make Real Time Data Sharing a Reality

Among the early accomplishments of the Powered for Patients project was enlisting many of the major providers of mechanical fault detection and automated reporting systems as active participants in the initiative. The companies include Automated Logic Corporation, a subsidiary of United Technology Corporation, Blue Pillar, Eaton and Schneider-Electric.  

While generally competitors on any given day, these companies are working jointly with Powered for Patients to help address the technology challenges associated with providing real time or near real time status reports to government officials and utilities. Since each of these companies provides its clients with their own type of alerts when emergency power is threatened, the Powered for Patients project will achieve another milestone by having its Dashboard synthesize each company’s data streams into a single data stream populating its online dashboard with red, yellow, green threat level indicator. This dashboard will provide government officials and utilities with a quick-glance view of unfolding threats to emergency power as well as updates on the status of response activities.

To achieve this ambitious goal, Powered for Patients has partnered with Talus Analytics, a women-owned business that specializes in translating complex data into actionable information. Led by PhD-level scientists with experience in real-time operations support, Talus has extensive experience coordinating data sharing and facilitating effective, data-driven decision making. Talus has done previous work for DHS and FEMA and is currently providing support to the CDC on another project related to sharing hospital status information with government officials to enhance disaster response.

Stakeholder Engagement Process Helps Create New Protocol Needed to Govern Real Time Information Sharing

As part of its Security & Resilience Challenge project, Powered for Patients launched a stakeholder engagement initiative to elicit input on pressing questions around how real time generator status reports from hospitals will be shared with government officials and utilities. A key consideration has been balancing privacy concerns of facilities with the need to give government officials and utilities enough real time or near real time information to enable accelerated response. Powered for Patients has worked with the four technology providers to develop an information sharing approach in which no hospital emergency power status data will actually be shared with Powered for Patients. Instead, these fault detection and automated reporting companies will provide a data feed on behalf of their clients through a secure Application Program Interface (API) that provides only the status information needed to populate the Dashboard’s red, yellow, green threat level indicator.

Input was sought from government officials and hospitals to inform the development of a voluntary protocol to govern communications and response activities of these stakeholders when real time or near real time alerts about threats to emergency power are transmitted through the Dashboard.

A number of hospitals and hospital systems across the country have engaged with Powered for Patients on the project. Miami Valley Hospital in Dayton, Ohio and Texas Health Resources, a 14-hospital health system in Texas, have signed on as a pilot sites to test live data sharing, a key step before the data sharing protocol can be finalized. UCI Health, part of the University of California Health System, will be providing input on the new information sharing protocol and is assessing opportunities to engage as a pilot test site. Huntington Hospital in Pasadena will also be helping with the development of the new information sharing protocol as will the Martin Luther King Hospital in Los Angeles.

Powered for Patients is working closely with the American Hospital Association (AHA), and its professional membership group, the American Society for Health Care Engineering (ASHE), to recruit additional facilities for the project. AHA and ASHE also provided input on the creation of the voluntary protocol that will govern emergency power status sharing by hospitals with government officials and utilities through the Dashboard.  State hospital associations taking an active role include the California Hospital Association, the Florida Hospital Association and the Texas Hospital Association.

To help ensure input from local and state emergency managers and public health officials on the information sharing protocol, Powered for Patients has partnered with the National Emergency Management Association (NEMA), the Association for State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO) and the International Association of Emergency Managers (IAEM). 

“Powered for Patients is grateful to the many stakeholders that are working closely with us to help leverage life-saving technology in an unprecedented way,” said Eric Cote, Project Director and Founder of Powered for Patients. “Having hospitals and other critical health care facilities share real time or near real time generator status reports with government officials and utilities during a disaster through our Dashboard represents a major breakthrough in improving situational awareness. Adding to this success by synthesizing multiple vendor data streams into a single data stream that populates the dashboard with a threat level indicator will be a groundbreaking accomplishment.”   

Cote credited the technology companies involved in the project for making major contributions to the initiative. “We applaud the technology companies that have worked closely with us to share valuable information about their technology along with their insights on how our Dashboard synthesizing their data feeds can be optimally developed,” said Cote. “We look forward to continuing our work with these companies beyond the current project to help commercialize the prototype we’re developing to enable all critical facilities using fault detection and automated reporting technology to share near real time data with government officials and utilities.”

Powered for Patients Receives DHS Funding to Leverage Real Time Emergency Power System Status Reports During Disasters

Powered for Patients is excited to announce that a proposed research initiative it submitted to the Department of Homeland Security has been selected as one of ten innovative research and development programs as part of the DHS 2018 National Infrastructure Protection Plan (NIPP) Security & Resilience Challenge.

Funding and support for the project is provided by the U.S. Department of Homeland Security, National Protection and Programs Directorate, Office of Infrastructure Protection, through the National Infrastructure Protection Program Security & Resilience Challenge, which is implemented by the National Institute for Hometown Security (NIHS).

Through the DHS project, Powered for Patients and its technology partner Talus Analytics will create a prototype to consolidate data streams from various remote monitoring and automated reporting systems connected to emergency power systems into a single data feed with a Red, Yellow, and Green risk indicator scale.

“This DHS award is a great honor and provides us with a tremendous opportunity to demonstrate the value of improving situational awareness of emergency power system status for government officials and utilities when emergency power is threatened at critical healthcare facilities during disasters,” said Powered for Patients Project Director Eric Cote.

The prototype Powered for Patients is developing with Talus Analytics will provide government officials and utilities with a single dashboard through which to view and assess unfolding threats to emergency power at hospitals impacted by disaster across the U.S. In addition to hospitals, this real time information sharing about generator status will be sought for large dialysis centers and nursing homes and the water systems and waste water treatment systems serving critical healthcare facilities.

Real time awareness of threats to emergency power will enable accelerated response by government officials in forestalling the loss of emergency power through deployment of temporary generators or generator fuel. For utilities, this early warning could enable utilities to shift restoration priorities and restore utility power prior to the loss of emergency power.  

“The success of this exciting project will depend on the active engagement of stakeholders in government, healthcare, the utility sector and the emergency power industry including those companies with proven fault detection and automated reporting systems,” said Cote. “I look forward to continuing to engage with key stakeholders in the weeks and months ahead.” 

The following stakeholder pages have been set up on the Powered for Patients website to provide additional details about how individual stakeholders can participate in the project. 

Government Stakeholders
Healthcare Facility Stakeholders
Emergency Power System and Fault Detection Technology Providers
Electric Utilities
Water and Waste Water Treatment Utilities

Powered for Patients is grateful to the many stakeholders that have engaged in this project, including:

Government Partners

  • Association of State and Territorial Health Officials (ASTHO)
  • International Association of Emergency Managers (IAEM) 
  • National Emergency Management Association (NEMA)

Healthcare Sector Partners

  • American Hospital Association (AHA)
  • American Society for Healthcare Engineering (ASHE)
  • Florida Hospital Association
  • Tufts Medical Center

Technology Partners

  • Blue Pillar, Inc.
  • Cummins
  • Eaton
  • EcoEnergy, Subsidiary of United Technologies Corporation
  • Expert MicroSystems
  • Schneider-Electric
  • United Technologies Corporation

To learn more about the Powered for Patients DHS NIPP Security & Resilience Challenge award, please visit the project page on the Powered for Patients website.

Powered for Patients Providing Guidance on Safeguarding Emergency Power for States in Hurricane Florence’s Path

Washington, D.C. – September 10, 2018 – As the threat of Hurricane Florence intensifies, Powered for Patients, a 501c3 non-profit created after Hurricane Sandy, is urging government officials, utilities and healthcare facilities in Florence’s path to take important steps now to safeguard emergency power and accelerate prioritized power restoration for critical healthcare facilities impacted by Hurricane Florence.

Powered for Patients was created in the aftermath of Hurricane Sandy when the failure of emergency power systems at six New York City area hospitals prompted emergency evacuations. The non-profit’s mission is to safeguard emergency power and expedite power restoration for critical healthcare facilities by fostering increased collaboration and information sharing between critical healthcare facilities, government and utilities when emergency power is threatened during disasters.

“Hurricane Florence can be expected to produce prolonged power outages that will seriously challenge the ability of emergency power systems to operate for the duration of the power outage,” said Eric Cote, Project Director for Powered for Patients. “This reality makes it critically important for facility managers at hospitals, skilled nursing facilities and dialysis centers take steps now to ensure that their emergency power systems are as prepared as possible for extended operation. This preparation includes a careful review of critical system components, topping off fuel tanks and checking spare parts inventory.”

Powered for Patients has published an Emergency Power System Resilience Checklist that details the key steps facility managers should take before, during and after a disaster to safeguard emergency power systems. This checklist, based on FEMA guidance, also includes a spare parts checklist to help facility managers inventory spare parts and address shortages prior to Florence’s landfall. (See attached checklists) These checklist are part of Protecting Patients When Disaster Strikes, a Playbook for safeguarding emergency power and expediting power restoration published in 2017 with Department of Homeland Security funding by Powered for Patients and the Rhode Island Emergency Management Agency. While developed for use in the State of Rhode Island, much of the Playbook’s content is applicable for any state impacted by a disaster.  

Powered for Patients is also urging emergency managers, public health officials and utilities to review protocols for how threats to emergency power and prioritized restoration for critical healthcare facilities should be addressed. These protocols should detail how a facility should notify government officials and utilities of a threat to emergency power and how government, utilities and impacted facilities should communicate to address any unforeseen threats to patient safety due to power outages or a loss of emergency power.  These protocols should be shared with all critical healthcare facilities before Hurricane Florence strikes. 

“We’ve learned from previous disasters that there is often a lack of clarify around the steps critical healthcare facilities should take in terms of communicating with government officials and utilities if there is a threat to patient safety arising from the lack of utility power or the loss of emergency power,” said Cote. “This uncertainty can put patient safety at risk.”   

In 2017, Powered for Patients introduced a new early warning protocol that calls on critical healthcare facilities in a disaster area to provide an early warning to a designated government official at the first sign of any threat to emergency power. This early warning can give government officials a critical head start in replacing generators if service crews are unable to resolve a mechanical threat and it also enables utilities to shift restoration priorities to restore power to a facility before emergency power is lost.

This new protocol was published in Protecting Patients When Disaster Strikes and in Roadmap to Resiliency, a white paper co-authored by Powered for Patients and the American Society for Healthcare Engineering (ASHE), a personal membership group of the American Hospital Association.

“Providing early warning of a threat to emergency power is the optimal best practice but this can’t happen if a healthcare facility doesn’t know who in government or at their utility they should contact and when once a threat to emergency power is detected,” said Cote.

Cote urged emergency managers, public health officials, utilities and critical healthcare facility administrators to address these critical communication protocols before Hurricane Florence strikes.

Put to the Test: A look at the 2017 Hurricane Season and the Largest Federal Generator Deployment in U.S. History

In late 2017, Powered for Patients Project Director Eric Cote had the privilege of meeting with leaders from FEMA and the U.S. Army Corps of Engineers (USACE) to learn about the challenges these agencies faced in addressing the temporary emergency power needs triggered by the unprecedented 2017 hurricane season.  

The official FEMA and USACE After-Action reports, still being developed, will tell a more detailed story of the 2017 federal temporary power mission which saw the highest number of federal generator deployments in the program’s history. As this full story emerges, there will be many opportunities to document lessons learned that can help better safeguard emergency power in future disasters. Powered for Patients looks forward to contributing to this important work.

In the interim, Powered for Patients is pleased to share this preliminary picture of the herculean effort launched by FEMA and USACE to meet the emergency power needs of those impacted by Hurricanes Harvey, Irma and Maria.  

Numbers at a Glance Behind the 2017 Federal Generator Deployments

                                                                                                                           # of Generators deployed                                            Texas (Hurricane Harvey)                                                                                                              45                                          

Florida (Hurricane Irma)                                                                                                                42

U.S. Virgin Islands (Hurricanes Irma and Maria)                                                                   180

Puerto Rico (Hurricane Maria)                                                                                                    1456

Totals                                                                                                                                                 1,723

Key Highlights of FEMA/USACE 2017 Temporary Power Mission

  • The overwhelming majority of generator installations were for facilities that had no existing emergency power capabilities. Of the 1456 generators deployed in Puerto Rico, 1140 fell into this category. The additional 316 federal generator deployments were for facilities that either needed additional emergency power capacity or had emergency power that failed. (Approximately 100 generator deployments in Puerto Rico were to replace failed generators).
  • Not all requests for federal temporary power assistance were routed through the proper channels. The requests outside official channels resulted in slight delays in processing requests as they had to be rerouted through the proper chain of command. (Requests for temporary federal power support must come from a state/territorial/tribal governor or the state/territorial/tribal emergency management agency).
  • FEMA and USACE established 8 microgrids in Puerto Rico to feed power back into the existing electrical grid.
  • Of the 180 generator installations in the U.S. Virgin Islands, approximately 30 remained in use as of late January 2018.
  • Of the 1456 generators installed in Puerto Rico, 140 had been removed as of late January 2018.
  • Supplying the 1723 generators deployed by the federal government in response to Hurricanes Harvey, Irma and Maria required FEMA to request support from the U.S. Defense Logistics Agency which triggered all of its existing private sector generator contracts to meet the demand. Approximately 1,100 generators were sourced through these private sector contracts with the balance coming from the FEMA fleet.
  • The massive demand for diesel fuel generated by the unprecedented deployment of federal generators in Puerto Rico and the U.S. Virgin Islands was very capably met by the U.S. Defense Logistics Agency.
  • Many of the generators needed in Puerto Rico and the U.S. Virgin Islands were in the smaller size range of 25kw to 75kw, seriously stretching the collective inventory of FEMA and the Defense Logistic Agency’s private contractors. Conversely, there was a surplus of large generators (750kw and above).

Addressing Critical Questions

In assessing the initial details about the federal temporary power mission triggered by the 2017 hurricane season, Powered for Patients looks forward to exploring these key questions with key stakeholders: 

  1. Most of the 1723 federal generator deployments went to facilities that had no emergency power capabilities but were deemed critical enough to warrant federal deployments. What types of facilities were involved and why didn’t these facilities have emergency power capabilities to begin with?
  2. What changes should be considered to encourage broader use of emergency power for these types of facilities?
  3. Approximately 220 generator deployments in Puerto Rico augmented existing emergency power that was considered insufficient. Which facilities received these and how will these facilities bolster emergency power for future disasters?
  4. In terms of the generators that failed in Puerto Rico, what were the primary causes of failure? Addressing this question will provide valuable lessons learned for facility managers and emergency power system operators.
  5. For all of the federal deployments to replace failed generators, what was the timeline and communications process associated with the request for assistance and deployment of temporary power? Detailing this timeline, and the communications process leading to a federal deployment, will provide valuable insight into opportunities for process improvement and accelerated responses when emergency power is threatened.

As answers become available to these questions, we look forward to sharing them. If you have questions beyond those detailed above that you’d like Powered for Patients to follow up on, please email Project Director Eric Cote at cote@poweredforpatients.org.  

Powered for Patients is grateful to FEMA and USACE leaders for the valuable information they’ve shared that enabled Powered for Patients to provide this initial report. Their tireless work and that of their federal colleagues, along with the private sector contractors mobilized by the Defense Logistics Agency, is an excellent reminder that effective disaster planning and response continues to be rooted in public-private partnership.

Powered for Patients Joins Congresswoman Frederica Wilson in Addressing Nursing Home Deaths

 

On September 19th, Powered for Patients Project Director Eric Cote was invited to join U.S. Representative Frederica Wilson (FL-27) at a Town Hall meeting in North Miami, FL where the Congresswoman addressed the tragic deaths that occurred earlier that week at the Hollywood Hills Rehabilitation Center. The heat-related deaths of more than a dozen elderly residents resulted from the loss of power to the facilities’ air conditioning system which was not connected to emergency power.

The Congresswoman announced the formation of a Task Force to ensure that a similar tragedy would never occur again. At her Town Hall meeting, the Congresswoman asked Cote to speak about the work of Powered for Patients how it could help advance the mission of the Congresswoman’s newly formed task force.

As part of her continuing work to address the nursing home deaths, Congresswoman Wilson will be hosting a field hearing in North Miami of the House Transportation and Infrastructure Subcommittee on Economic Development, Public Buildings and Emergency Management on Thursday, October 19th. This Congressional subcommittee has oversight responsibility for FEMA. The Congresswoman has asked Powered for Patients to provide testimony for this hearing.

Powered for Patients Addresses Florida Nursing Homes Deaths

September 15, 2017 – Powered for Patients addressed the emergency power requirements for nursing homes today following the tragic death Wednesday of eight patients at a Hollywood, Florida nursing home after the loss of the facility’s air conditioning.

Early media reporting about this incident included some incorrect and contradictory information about emergency power requirements for nursing homes. Powered for Patients Project Director Eric Cote noted that there are no State of Florida requirements or federal requirements in place today that require nursing homes or hospitals to have air conditioning systems connected to an emergency power source. While this is an optimal best practice, this won’t be a requirement until November 2017 when the federal government’s new emergency preparedness requirements for healthcare facilities accepting Medicaid and Medicare reimbursements take effect.

Among the new federal rules is a requirement that hospitals, nursing homes and long-term care facilities be able to maintain safe temperatures when utility power is lost. It is expected that most facilities will comply with this new requirement by connecting air conditioning systems to emergency power.

“The loss of life in the Hollywood, FL nursing home, currently attributed to lack of air conditioning, is not a new threat to patients following hurricanes,” said Cote. “Among the painful lessons learned after Hurricane Katrina was the potentially deadly impact lack of air conditioning can have on elderly or compromised patients when power outages extend for days. The new federal requirements will better protect patient health when extended power outages can turn heat and humidity into deadly threats.”

Currently, emergency power is required for nursing homes and long-term care (LTC) facilities if the nursing home/LTC-facility has an electric-operated fire suppression system, an elevator or any life support equipment for patients. Egress lighting is also required to have a backup power source. The source of emergency power used by nursing homes to meet these backup power requirements does not have to be a generator if other sources of alternative power exist. In the case of egress lighting, batteries can generally meet the emergency power need. However, in the majority of cases, generators are used to meet these emergency power requirements relating to fire suppression systems, life support equipment and elevators.

The facts Cote shared with media outlets were confirmed with leading experts on these matters, including a senior official with the National Fire Protection Association (NFPA), which authors the key fire and life safety codes that govern generator requirements for healthcare facilities. Cote also spoke with an official from the Florida Health Care Association, which represents many of Florida’s nursing homes and long-term care facilities.

In advance of the new federal requirement, Cote urged nursing homes and long-term care facilities to consider other steps to ensure patient comfort and safety, including:
• If a facility’s normal emergency power system doesn’t currently have the capacity to support operation of the air conditioning system, consider modifications to the facility’s electrical system to enable installation of temporary portable generators to support operation of the air conditioning system.
• Carefully follow emergency power system checklists to ensure optimal operations of emergency power systems before, during and after disaster. This will be especially important if additional generator capacity is added to cover some or all of the facility’s air conditioning system. This checklist is available in the appendix of Protecting Patients When Disaster Strikes, the Powered for Patients playbook on safeguarding emergency power.
• Determine in advance of a disaster who you can contact in government and at your utility to alert them to any mechanical threat to emergency power or problem accessing generator fuel following a disaster. This early warning gives government an important head start in helping to avert the loss of emergency power and it provides utilities the opportunity to modify prioritized restoration plans.
• Ask your generator service and fuel providers to be in contact with local emergency management officials to get assistance if storm damage or lack of fuel hinders the ability of these service providers to get to your facility to make repairs or provide refueling.

END

Death of Electricity Dependent Patient in Hurricane Harvey Offers Important Lesson for Those in Irma’s Path

September 6, 2017 – Powered for Patients has urged those in Hurricane Irma’s path to heed the tragic lesson from a Hurricane Harvey-related death attributed to power loss.

According to a September 4th article in the Houston Chronicle, an elderly woman died in her Santa Fe home on Saturday, August 26, after her oxygen tank failed when the electricity went out. The Chronicle reported that another woman died in Texas City after she was unable to get dialysis during the storm and flooding. The article citied reports from Orange County officials who said four of the county’s nine deaths were elderly people and possibly related to a power outage.

“The tragic death in Texas of an at-risk citizen who lost the use of her electric-powered medical device when the power went down is a sad reminder for other patients of the critical importance of addressing emergency power needs before disaster strikes,” said Eric Cote, project director for Powered for Patients. “As Hurricane Irma threatens Florida, it’s vitally important for citizens dependent on life sustaining, electric-powered medical equipment to prepare now.”

Among Powered for Patients’ recommendations for at-risk citizens in Irma’s path relying on electric-powered medical equipment in their homes:
• Fully charging the equipment’s batteries before power is lost.
• If you don’t have a backup battery and can secure one or more, do so and ensure that they remain fully charged.
• Identify a source of emergency power where equipment could be plugged in or backup batteries can be recharged. Possible sources of emergency power include neighbors with generators, local public safety facilities, businesses or shelters.

Powered for Patients also called upon citizens with home generators to help neighbors relying on electric-powered medical equipment. “Citizens with home generators can literally save a life if they can help ensure access to power for a neighbor who relies on life-sustaining medical equipment until power can be restored,” said Cote.

For dialysis patients who routinely use dialysis centers, Powered for Patients urges these patients to contact their facility now to discuss options that may include arranging dialysis ahead of schedule.

Powered for Patients is also recommending that public officials, hospitals and utilities use the federal government’s emPOWER map ahead of Irma’s landfall to better anticipate the needs of electricity dependent citizens. The emPOWER tool was developed by the U.S. Department of Health and Human Services to provide officials with a better understanding of the number of at-risk citizens in a community who rely on electric-powered medical equipment. The emPOWER tool helps officials better understand the types of emergency resources that may be needed in an emergency and enables hospitals, healthcare coalitions and first responders to anticipate and plan for a surge in assistance requests and demands for care during a prolonged power outage or other emergency.

The emPOWER tool can also help local electric companies identify the areas that will require prioritized power restoration to protect health and save lives. Community businesses and civic organizations can use the data to identify ways to provide support to the community in an emergency, such as providing access to power to help individuals recharge their batteries.

Online Powered for Patients Playbook Can Help Facility Managers at Hospitals and Other Critical Healthcare Facilities Better Safeguard Emergency Power in Advance of Irma

To help facility managers at hospitals and other critical healthcare facilities safeguard emergency power systems in advance of Irma, Powered for Patients has posted Protecting Patients When Disaster Strikes on its website. The playbook includes a detailed checklist in its appendix that facility managers can use before, during and after disaster to safeguard emergency power.

The playbook was developed with Department of Homeland Security funding in conjunction with the Rhode Island Emergency Management Agency. While the existing version of the Playbook was developed for Rhode Island, much of the content of the playbook, including the checklists for safeguarding emergency power systems, is applicable anywhere in the country.