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Los Angeles County EMS Agency Tackles Aging Hospital Generator Fleet with Deployment of Advanced, Real-Time Generator Monitoring Technology

Deployment of Power P.I.O.N.E.E.R. Tool to County’s Single Generator Hospitals Will Provide Unprecedented Situational Awareness of Generator Failures During Power Outages

The Los Angeles County Emergency Medical Services (EMS) Agency is tackling the county’s challenge of an aging hospital generator fleet by deploying an advanced technology that will provide automated, real-time alerts anytime a hospital generator experiences a mechanical problem during a power outage.

Recently, the Power P.I.O.N.E.E.R.® tool was installed at two of Los Angeles County’s single-generator, acute care hospitals. P.I.O.N.E.E.R.®, which stands for Power Information Needed to Expedite Emergency Response, continuously monitors generator performance and sends automated, real-time warnings to designated individuals anytime a generator experiences a mechanical problem during a power outage.  

The deployments represent the first time a U.S. hospital is making automated, real-time generator threat alerts available to government emergency managers. These real-time alerts are a major improvement in situational awareness and will enable accelerated deployment of government generators and provide a valuable head start in planning for a potential hospital evacuation. The early warnings will also give utilities the opportunity to quickly assess options for prioritized power restoration including switching feeder lines to a hospital in cases where two lines exist and one of them is still able to provide power to the hospital. 

Deployment of Power P.I.O.N.E.E.R. to single generator hospitals was considered especially important since these facilities have no redundant emergency power, and as a result, put patients at greater risk if the facilities experience a total loss of emergency power. The LA County EMS Agency is tapping its HHS Hospital Preparedness Program (HPP) funding to cover the cost of deploying the Power P.I.O.N.E.E.R. tool in the county’s single generator hospitals.

Power P.I.O.N.E.E.R.® was developed by the 501c3 non-profit Powered for Patients as part of a Department of Homeland Security-funded initiative to spur advances in generator monitoring technology that would provide an early warning to government officials and utilities when critical facilities face a threat to emergency power during an outage. Power P.I.O.N.E.E.R. is also designed to provide ongoing, real-time updates on the status of efforts by government officials, utilities and service providers to respond to a stricken facility.  Powered for Patients has been leading an emergency power preparedness initiative for the LA County EMS Agency since May 2019. The multi-year initiative was launched to help ensure that Los Angeles County and its municipalities, along with its electric utilities and critical healthcare facilities, are employing best practices in minimizing threats to emergency power and expediting government, utility and private sector response when threats to emergency power arise during power outages.

“Given the ongoing threat of Public Safety Power Shutoffs, and the potential for other types of power outages in Los Angeles County, we’re excited to see Power P.I.O.N.E.E.R. providing real time situational awareness of generator threats at the county’s single generator hospitals,” said Eric Cote, Project Director for Powered for Patients. “This visibility is especially important since single-generator hospitals have no redundant emergency power and in some cases are relying on older generators. As more of LA County’s single-generator hospitals deploy Power P.I.O.N.E.E.R., the impact of this powerful new tool in protecting patients will become even greater.”  

Concern about outdated hospital generators in Los Angeles County is driven by a recently completed analysis documenting a seriously aging fleet. The analysis of the generator fleet in Los Angeles County’s hospitals is part of the LA County EMS Agency’s ongoing emergency power preparedness initiative being led by Powered for Patients.  The analysis reflects survey data from the county’s 80 hospitals that participate in the Hospital Preparedness Program which have a combined total of 271 generators. The useful life expectancy of a generator is approximately 30 years of age and the recent analysis showed that 87 out of the 271 generators, or 32 percent, are older than 30 years of age, with 40 of these generators between 40 and 49 years of age and 15 of the generators older than 50 years of age.

Among LA county’s 14 single-generator acute care hospitals that participate in the Hospital Preparedness Program, nine of these facilities, or 64 percent, have generators over 30 years of age, including three with generators between 40 and 49 years of age, three with generators between 50 and 59 years of age and one with a generator that is over 60 years old.  There are no federal or state requirements that limit the age of a hospital generator as long as the generator can pass periodic tests. However, Cote noted that these tests don’t represent the true challenge an aging generator would face if it were required to operate continuously for extended periods of time.  

Despite the aging fleet, the analysis showed some positive signs when it comes to investment by hospitals in new generators. Over the past ten years, Los Angeles County hospitals have collectively purchased 48 new generators.

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.  

Rhode Island Stakeholder Engagement Initiative

Rhode Island Emergency Management Agency Stakeholder Engagement Initiative Advances New Protocols to Help Strengthen Emergency Power for Rhode Island’s Critical Healthcare Facilities

The DHS-funded Stakeholder Engagement Initiative launched by the Rhode Island Emergency Management Agency (RIEMA) and Powered for Patients in October 2015 is completed and will help set the stage for similar initiatives in other states. Key state stakeholders involved in the project have included the Rhode Island Department of Health; the Rhode Island Office of Energy Resources; National Grid, the state’s primary electric utility; and the Hospital Association of Rhode Island. Several federal agencies have been active participants including FEMA, DHS, and HHS.

After more than a year of stakeholder meetings, emergency power system vulnerability assessments and strategic planning, a key outcome of the initiative is the comprehensive Playbook, entitled Protecting Patients When Disaster Strikes.

The Playbook details the key responsibilities of stakeholders across a four-phase planning and operational continuum to safeguard emergency power systems and expedite power restoration.

The Playbook also introduces new protocols to provide an early warning to state officials when hospital generator power is threatened during a disaster. These new protocols are expected to become a national model for enhancing situational awareness of emergency power system status during disasters.  

 

 

 

 

Powered for Patients Promotes Mission at 2015 Preparedness Summit

Powered for Patients Project Director Eric Cote took part in a presentation at the recent 2015 Preparedness Summit in Atlanta, GA that addressed the consequences of power failures for hospitals. Cote provided an overview of the work of Powered for Patients in safeguarding backup power and expediting power restoration for hospitals and other critical healthcare facilities. Cote’s presentation was one of two during the 90-minute session that included a presentation from West Virginia University Law Professor James Van Nostrand on Combined Heat Power systems as an alternative to backup generators.

While at the Preparedness Summit, Cote also had the opportunity to meet with senior public health preparedness officials from a number of states to discuss launching State Stakeholder Engagement Initiatives.

Closer Ties Between Hospitals and Utilities Forged at Edison Electric Institute Conference

To help Powered for Patients facilitate enhanced dialogue between hospitals and utilities, Jonathan Flannery, the Senior Associate Director of Advocacy for the American Society of Healthcare Engineering (ASHE), led an ASHE delegation on behalf of Powered for Patients to the Edison Electric Institute’s Key Account Manager conference in New Orleans earlier this year. Jonathan was a presenter at our initial stakeholder meeting in 2014 and has been a steadfast supporter since.

The Edison Electric Institute (EEI) is a national trade association that represents the nation’s investor-owned utilities which comprise 70 percent of the electric utility sector. EEI invited Powered for Patients and ASHE to attend its upcoming National Key Accounts Workshop to help begin the process of building closer connections between utilities and hospital facility managers.
Flannery provided a briefing about Powered for Patients to a group of utility executives that was very well received. Several utilities in attendance asked for immediate follow up discussions to explore working with Powered for Patients. In addition, Flannery and nearly a dozen hospital facility managers from Louisiana sat down for a face-to-face discussion with the utilities serving these hospitals. This was an excellent continuation of the work Powered for Patients has initiated in bolstering dialogue between hospital facility managers and their utilities. We are grateful to Jonathan Flannery for representing Powered for Patients at the meeting and we express our gratitude to EEI for providing the opportunity.

Powered for Patients Takes Part in Experts’ Roundtable on Widespread Grid Outage

Powered for Patients was the only healthcare-focused organization that took part in a high-level Roundtable in Washington, D.C. with federal officials, cyber security experts and utility industry representatives to address the implications of a long-term power outage on critical healthcare facilities.

The Experts’ Roundtable on Preparing for a Potential Prolonged and Widespread Outage of the Electric Power Grid was an off-the-record discussion among state, federal, and private sector interests to help frame the topic of widespread or prolonged power outages for elected leaders; gather input on how elected officials are currently addressing this topic and could improve their preparation and planning; and discuss how to share best or promising practices.

Powered for Patients Releases Report on Initial Stakeholders Meeting

A select group of key stakeholders gathered in Washington, D.C. on August 19, 2014 for a day-long meeting to discuss how to better ensure backup power and utility power for critical healthcare facilities impacted by disaster.

The official report of that meeting was released in late October 2014. Those participating in the meeting included federal, state and local public health officials and emergency managers, and representatives from the power generation industry, the utility sector and the healthcare industry.

The Powered for Patients Initial Stakeholder Meeting was co-sponsored by the Association of State and Territorial Health Officials (ASTHO), the National Association of County and City Health Officials (NACCHO), and the National Emergency Management Association (NEMA). All three organizations are working closely to advance Powered for Patients in collaboration with the Office of the Assistant Secretary for Preparedness and Response (ASPR) at the U.S. Department of Health and Human Services.

The Stakeholder Meeting addressed critical lessons from Hurricane Sandy and other disasters that continue to shape policy discussions and programming at ASTHO, NACCHO, NEMA and other leading public health and emergency management organizations. Among the key lessons learned was the need to protect backup power for critical healthcare facilities to avoid emergency evacuations. The need to enhance power restoration prioritization for critical healthcare facilities also became evident.

Key topics discussed at the August 19th meeting included:

  • Lessons learned about backup power from Hurricane Sandy and previous disasters, and progress made (or not) in heeding lessons learned.
  • Overview of the current approach to power restoration decision-making and opportunities to accelerate restoration for critical healthcare facilities.
  • The state of the generator fleet and opportunities to enhance reliability and performance of backup power systems for critical healthcare facilities.
  • Opportunities to enhance situational awareness of generator status for disaster-impacted healthcare facilities through the use of remotely monitored generator data or other means.
  • The technical and operational challenges faced by the generator industry, healthcare facilities and utilities during disasters and opportunities for government to assist in addressing these challenges.

“We were very pleased to help convene this important meeting of the key stakeholders involved in ensuring backup power and restoring utility power for critical healthcare facilities,” said Gerrit Bakker, Senior Director, Public Health Preparedness for ASTHO. “This meeting has given us a clearer sense of the challenges faced by key stakeholders and the opportunities to overcome these challenges through coordination.”

Participation in the initial stakeholder meeting was limited to a small working group to enable a productive initial discussion among key stakeholders. However, broad involvement from stakeholder communities is encouraged.  For a full copy of the Stakeholder Meeting Report, or for more information about working with Powered for Patients, contact Project Director Eric Cote, at cote@disastersafetystrategies.com.