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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.

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.

 

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.

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

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.