Blackouts, floods & hospitals

John Taylor: November 01, 20120 Comments

There’s no shortage of lessons for hospitals from Superstorm Sandy. “Hospital preparedness and well-functioning backup systems are a costly distraction from daily business, until they are needed. Like now,” wrote Dr. Arthur Kellermann, about the power failure that forced evacuations of hundreds of patients from NYU Langone Medical Center as Sandy flooded lower Manhattan.

Hospitals along the East Coast saw their backup generators fail in the frenzy of the storm. Teams of staff and first responders hauled patients down staircase after flash-lighted staircase as some hand-pumped oxygen to their critically ill patients.

“Preparedness is not simply a hoop to jump through to satisfy Joint Commission or to keep the fire marshal off your back,” Kellerman wrote to the ProPublica website. “Assuming nothing will ever happen, or counting on your staff to ‘rise to the occasion’ is not a plan, and it is not preparedness.”

At some of the troubled East Coast hospitals, their generators – and backup generators – were below ground level. When a storm surge topped them off, down they went. Some generators were on higher floors, but the fuel pumps for the generators were in the basement. The systems may well have “been in compliance” -- met the numerous tests required by the Joint Commission or others. But the costly retrofitting and relocation of these aortas of often-aging hospitals, well, the public may never know where that fit on a five-year capital projects list.

I’ve experienced blackouts all over the country – most frequently in my hometown of New York and in Fresno – but never in a hospital. And while I’ve battened down through hurricanes – in a New York or Connecticut apartment and on a cruise ship – I’ve never been through a flood. The tragedy of Sandy made me recollect the Average Joe advantages and disadvantages of living on the first floor vs. living a dozen flights of stairs from ground level.

Ground floor/basements – where you store your heirlooms; where you temporarily store your trash, pesticides, gas cans; repository of your heating/air-conditioning units. When power goes out, it’s inconvenient but it’s not a hike.

Higher levels --- without lights or an elevator, you haul buckets of water to flush your toilet; it’s where you feel a bit safer from the darkened outside world but also exist in an outpost – you can dehydrate, suffocate, freeze and hallucinate till someone eventually pays attention.

So, as Eastern hospitals get regulatory leeway to cram all the additional patients from evacuated facilities into non-clinical areas, there are reasons to be thankful – not the least being, it’s not the flu season. But as hospital disaster planning expert Dr. Dan Hanfling told ProPublica, hospitals that are part of our aging national infrastructure must prepare for a “new normal” in which patient evacuations are no longer unexpected events.

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