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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.

Washington Post Story Highlights Powered for Patients on Nursing Home Fatalities

As part of its coverage of nursing home fatalities in Hollywood, Florida, the Washington Post interviewed Powered for Patients Project Director Eric Cote to address current requirements for connecting air conditioning systems to an emergency power source in nursing homes. In the article, Cote notes that federal requirements for hospitals and nursing homes to maintain temperatures during power losses won’t take effect until November 2017.

Protecting Patients When Disaster Strikes Playbook on Safeguarding Emergency Power Formally Unveiled

Providence, RI – August 24, 2017 – Emergency management officials, public health leaders, and healthcare facility administrators gathered at Women & Infants Hospital on Thursday for the presentation of Protecting Patients When Disaster Strikes, a new playbook that will be used to advance Rhode Island’s work to safeguard the emergency power needs of critical healthcare facilities before disasters strike.

The clear, centralized guidance in Protecting Patients When Disaster Strikes derives from years of emergency preparedness planning and training by the Rhode Island Emergency Management Agency (RIEMA), the Rhode Island Department of Health (RIDOH), the Healthcare Coalition of Rhode Island, healthcare facilities, and other partners. Although the event was held at Women & Infants Hospital, all healthcare facilities can use the playbook, including nursing homes, health centers, and assisted living communities, as well as other community organizations.

“Rhode Island is susceptible to power outages stemming from natural disasters such as hurricanes, winter storms, floods, as well as human-caused and technological incidents. Protecting our citizenry and critical infrastructure is the top priority of our agency. Therefore, it is crucial that we work together as a state to assist critical facilities that are dependent on power to provide support to Rhode Island’s most vulnerable populations,” said RIEMA Director Peter Gaynor.

“Climate change and cyber threats are just two of the emerging issues we must be mindful of as we look forward and work to secure Rhode Island’s power infrastructure,” said Director of Health Nicole Alexander-Scott, MD, MPH. “RIDOH’s Center for Emergency Preparedness and Response has done tremendous work with hospitals and emergency preparedness partners throughout the state on planning for and training for emergencies, as well as learning from actual incidents. Protecting Patients When Disaster Strikes will help smaller facilities such as nursing homes, health centers, and assisted living communities, follow their lead and ensure that all Rhode Islanders, including the state’s most vulnerable populations, will continue to get the health services and care they need during emergencies.”

“At Women & Infants Hospital, the safety of our patients, visitors, and staff is of utmost importance, and ensuring our readiness to respond in the case of an emergency or a disaster is critical,” said Diane Rafferty, interim president and chief operating officer, Women & Infants Hospital. “We are proud to be able to work collaboratively with the state agencies and other health care providers in planning for emergencies. This playbook will now be one more valuable tool in our preparedness toolbox.”

The playbook includes inventory material, emergency power supply contacts, facility manager checklists, and reporting information and is comprised of a four-phase planning process to help facilities safeguard their emergency power systems and expedite power restoration. The four phases are:

  • An assessment of potential power vulnerabilities and guidance on how to address vulnerabilities before a disaster occurs.
  • Guidance on how facilities can ensure reliable emergency power, should the grid go down.
  • Guidance on how to operate while under emergency conditions and how to sustain efforts during emergency power operations for four days or longer.
  • Information on the post-disaster recovery process, and how to best learn as an organization and most effectively prepare for subsequent emergencies.

Rhode Island is the first state to implement the initiative and will be a model for a nationwide push of the Powered for Patients program. Having officially entered hurricane season in June, the playbook could not have been completed at a better time. A copy of the playbook will be distributed to healthcare facilities and community partners through the state.

Protecting Patients When Disaster Strikes was developed using funding from the U.S. Department of Homeland Security. The playbook references partnerships with the U.S. Army Corps of Engineers, the Federal Emergency Management Agency, National Grid, the Hospital Association of Rhode Island, the American Society of Healthcare Engineering, and the U.S. Department of Health and Human Services, among other organizations. RIEMA and RIDOH’s Center for Emergency Preparedness and Response worked with the nonprofit Powered for Patients on its development.

“One of the key lessons learned after Hurricane Sandy was that federal officials lacked sufficient situational awareness of failing hospital generators. The Rhode Island initiative will help address this problem by developing a protocol for how to best share information about threats to backup power systems with government officials and utilities,” said Eric Cote, project director for Powered for Patients.

First DHS-funded, state-specific Stakeholder Engagement Initiative wrapping up with important findings and far reaching outcomes

The DHS-funded Stakeholder Engagement Initiative launched by the Rhode Island Emergency Management Agency (RIEMA) and Powered for Patients in October 2015 is nearing its conclusion 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 will be a 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 will also introduce new consensus protocols that can become a national model for enhancing situational awareness of emergency power system status during disasters. (More to come on this once the Playbook is officially published in the coming weeks.)

New Online FEMA Emergency Management Institute (EMI) Course on the ABC’s of Temporary Power (IS-815) Highlights the work of Powered for Patients

From its inception, Powered for Patients has worked closely with FEMA leaders and officials from the U.S. Army Corps of Engineers (USACE) responsible for the management and deployment of the federal fleet of temporary generators to meet the needs of critical infrastructure facilities whose generators fail during disasters.

A part of this work has been Powered for Patients’ active promotion of the FEMA/USACE online Emergency Power Facility Assessment Tool (EPFAT). A facility’s registration of its emergency power system through the online EPFAT system enables FEMA and USACE to accelerate deployment of temporary generators during a disaster.

As part of this ongoing collaboration, FEMA is helping to spread the word about the work of Powered for Patients.  FEMA’s new online Emergency Management Institute (EMI) course on the ABC’s of Temporary Power (IS-815), highlights the work of Powered for Patients. Information about the new FEMA course is available at https://training.fema.gov/is/courseoverview.aspx?code=IS-815

National Working Group on Information Sharing Advances

As Powered for Patients digs deeper into the role of remote monitoring and automated reporting technology in increasing situational awareness of at-risk emergency power systems during disasters, the need for a consensus protocol for leveraging this technology becomes even more evident.

Developing such a protocol is a key outcome of the National Working Group on Information Sharing, a new Powered for Patients initiative for which planning continues.  As this planning advances, Powered for Patients Project Director Eric Cote has received lots of input on this issue from hospital facility managers, remote monitoring technology providers and government officials.

While government officials are eager to tap the capability of remote monitoring and automated reporting technology to rapidly get status reports about hospital emergency power systems during disasters, a key challenge will be finding a way to vet information before it is passed up the chain of command. Many of the automatic notifications generated by remote monitoring technologies relate to mechanical threats that can often be resolved without problem. Yet, this technology also can automatically detect and rapidly alert facilities personnel to catastrophic mechanical failures that can signal an imminent loss of emergency power. The Powered for Patients initiative will work with key stakeholders to help develop protocols around rapidly sharing more urgent mechanical threat notifications up the chain of command.

The sooner government officials know of a mechanical threat that has the potential to disable an emergency power system, the faster government resources can be deployed to avert a failure. Similarly, accelerated notice to utilities of a potential failure of a hospital’s emergency power system during a disaster can enable reprioritization of restoration efforts.  Stakeholders interested in taking part in the National Working Group on Information Sharing are encouraged to contact Project Director Eric Cote at cote@poweredforpatients.org.