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Emergency planning: Preparing for a winter storm

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January 5, 2017

Emergency planning: Preparing for a winter storm

As the first flakes of winter start to fly, here’s your plan to keep your facility open and operational.

Editor’s note: This is the second of a series of articles addressing common planning concerns when it comes to certain types of emergencies that can strike a hospital facility.

Take a look out the window. If you’re in most parts of the U.S., you might see a blanket of white out there. If the snow hasn’t started falling yet, it’s a safe bet that it will be soon.

Most areas, and hospital facilities, are ready for the typical snowstorm. But are you ready for a truly bad snowstorm that can leave a region crippled for days, or even weeks at a time?

All you have to do is ask folks in places like Buffalo, New York, which was hit with 7 feet of snow in just one storm in November 2014. The monster storm also blanketed most of the Central U.S. and New England over a six-day period with amounts reaching record levels in many places. In many cities such as Boston and New York, services ground to a halt and citizens found themselves stranded.

Of course, a hospital can’t just shut down; it needs to remain open and ready to take in patients at any time. This is also a requirement. The Joint Commission already requires you to have a plan in place to prepare for “all hazards,” and similar new emergency preparedness requirements were recently adopted by the Department of Health and Human Services. These are meant to prevent the disruption of hospital services on a mass scale, such as that experienced during disasters such as Hurricane Katrina in New Orleans, and in New York City during Hurricane Sandy.

Given that a winter storm is a statistical certainty to occur during the colder winter months, what are some things you can do to help prepare your facility to ride out the storm? Allow us to help you form a plan. Also check out FEMA’s new resource that gives you a sample tabletop exercise that you can use to help your staff plan. See p. 4 for an example that you can tailor to your own needs.

Prepare to turn your hospital into a hotel. In September 2015, Pope Francis visited Philadelphia as part of his first-ever U.S. visit. With more than 3 million people estimated to visit the city, security was so tight in the downtown Philadelphia area that the Secret Service closed off a three-square-mile area that became known as “the box” to emergency planners. Essentially, traffic in and out of the downtown area was stopped for a week. As was seen in recent winters in places such as Atlanta and other less-prepared areas of the South—a good snowstorm can do the same thing. But neither Pope nor snow can stop a hospital from operating. So take a lesson from the folks in Philly who still had to get their staff into work. Instead of closing, facilities canceled visitations and elective surgeries, and made plans to “hotel” entire shifts of workers at the hospital to make sure they would be able to get to work.

“We were told to plan like this is a major snowstorm, but we had to take this one to extremes,” says Bernie Dyer, director of safety and emergency management for the University of Pennsylvania Health System, Philadelphia.

In a typical snowstorm, Dyer says his hospital might have 200 staff sleeping over, but in this case the hospital had to plan for 1,000 employees being housed and fed. A monster snowstorm might not keep your staff hunkered down for a week, but maybe you should have it in your plans to turn a conference room into a supply closet, or use the building under renovation or another seldom-used on-campus building as a temporary hotel for some of your staff sleeping over. Prepare to rent shower trailers if you don’t have enough bathrooms, and bring in catering for meals, while making sure there are table games, televisions, and quiet spaces staff can decompress in.

Prepare for the power to go out. It would seem an obvious piece of advice that hospitals should have a plan in place to keep power going, and in fact, it is a regulatory requirement that facilities have backup generators as well as emergency fuel on board and available in case of a blackout. You may well have a plan, but is it the best it can be? Ask hospitals in New York City—in the wake of Hurricane Sandy, and the many hospital blackouts that were caused when storm water flooded basements, government agencies such as FEMA started issuing new guidelines designed to help hospital engineers design backups for their backup systems. If they don’t have it in their library, tell your maintenance crew to download FEMA’s 170-page book, Emergency Power Systems for Critical Facilities: A Best Practices Approach to Improving Reliability. Known as FEMA P-1019 in the industry, the book was completed in September 2014 and last updated in February 2015. Check out and download the entire publication at goo.gl/CbcLgZ.
 

Consider the following tips extremely important. These are simple things that could mean the difference between a minor disruption in your services and a full-scale evacuation/desperate search to find a hospital that can take your critical patients during an emergency:

  • Can your generator be hooked up quickly? Some hospitals prefer to set their systems up so that a “quick connect” temporary generator (that can be trucked in) with a pre-installed connection can be quickly set up and connected. It doesn’t require constant testing and maintenance, and maintenance requirement can be given to outside vendors. For that matter, can vehicles get to the connection? Make sure there is a paved, plowed vehicle access road that can handle a large truck with a huge load (at least 10,000 pounds).
  • Can you trust your vendors? You need to establish vendor contracts ahead of time. During a blizzard, demand for fuel (and snowplows) will be high and it may be difficult or impossible for trucks to get to you to restock or refuel your site. Some hospitals have begun to form collaborations with fuel stations in their areas that would allow them to take over the inventory in the event of an emergency. Some even bought their own tanker trucks to store fuel stocks during storms.
  • Where do you keep your emergency fuel? Gone are the days when it was considered smart practice to store emergency fuel in underground tanks or in basements. During Sandy, and many other disasters such as the 2011 tornado in Joplin, Missouri, emergency fuel stocks were rendered impossible to access or contaminated by floodwater or debris. New buildings, such as the brand-new Spaulding Rehabilitation Hospital in Boston, are being designed with what is called “upside-down” construction, where the main primary electrical services are located in the rooftop and powered by a fuel pump that is secured in a flood-proof vault with a 150,000-gallon tank and reserve fuel stored on site. At the very least, secure your fuel stores in concrete bunkers and make certain there is a way to get to them.


Maintain your grounds. You may have the most foolproof, ready-to-go action plan ever. But that’s all lost if a worker or visitor gets killed by a large tree limb that falls on a car during a heavy snowstorm. You need to make sure to assess the outside of your facility to determine the damage that could occur from your surroundings during a blizzard. Are your drains clear? Is your facility near a river that could be susceptible to ice dams? If so, if you’re in a ?ood plain, do you have a plan to sandbag around low-lying areas?

“We are always thinking about how [secure] is our roof structure, and whether we are sure drains and capabilities to get rid of water is okay,” says Steven Shay, safety coordinator for Winchester (Massachusetts) Hospital. Shay learned this lesson the hard way when his own vehicle was struck by falling limbs in the parking lot during a heavy snowstorm. Pay close attention to making sure dead limbs on trees are removed every year, especially in areas such as walkways or parking lots where a windy storm could easily send a branch falling onto a car or person.

Reduce slips and falls. This is one of those perennial warnings that seem to be overused, and preventing slips on slippery floors seems to be common sense, yet injuries caused by slips, trips, and falls continue to rank among the biggest hazards for healthcare workers, according to OSHA. To prevent injuries to your workers and visitors, you need to have a robust plan in place to battle slippery and icy surfaces, both indoors and outdoors.

Start with your parking lots, and make sure you have a reliable contractor—and several backups on call—for when the big snow hits. If your primary contractor is busy, or can’t make it, you have to make sure the lots and the sidewalks are treated.

Your maintenance department needs to then concentrate on the entrances, routinely sanding and salting high-traffic areas that are prone to icing over (make sure you have backup staff, just in case). Then work your way indoors and take care of the hallways near your entrances, as they are likely to become slippery with melted snow and water and present a slipping hazard.

Heavy duty rubber mats in these high-traffic areas are a must in the winter months, and you also need to make sure they are properly anchored to the floor to make sure they don’t inadvertently become a tripping hazard. Lastly, remind all staff about the importance of proper footwear. Sturdy, closed-toe shoes with rubber soles are almost always the best way to go in healthcare, and in winter when the floors can be slick, they can save a person from slipping and injuring themselves.
 




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