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Know your hospital's electrical backup plan

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April 1, 2019

Recent 911 outages, transformer explosion highlight need for a Plan B

A series of recent electrical grid failures, including a massive transformer station explosion in New York City and nationwide 911 outages, showed what can happen when the grid goes haywire—and demonstrated the need for solid backup plans.

The first incident occurred on December 27, 2018, when a huge explosion at a Con Edison substation in Queens temporarily lit up New York’s night skyline in a brilliant blue.

The light came as part of an electrical fault that caused an “arc flash,” like lightning, according to published reports. According to officials, a brief electrical fire occurred after a “couple of transformers tripped offline.” The issue caused a transmission dip in the area. The equipment, located about 20 feet above the ground, contained cables that transmit 138,000 volts of electricity—a staggering amount compared with the 120 volts supplied to American households.

The arc flash resulted in several high-profile power outages. The Rikers Island prison complex, which houses about 10,000 inmates, lost power for about 25 minutes, and flights were delayed at the city’s LaGuardia Airport. Thankfully, St. Vincent’s Manhattan Hospital in Greenwich Village was the only medical center affected in New York City, and it switched over to a backup diesel generator.

Also on December 27, a nationwide outage by telecom giant CenturyLink prevented some customers from reaching 911 operators, prompting public safety officials to hand out 10-digit landline phone numbers for callers to reach help in the event of an emergency. Four Banner Health hospitals in Colorado, Wyoming, and Nebraska lost internet service—and thus their access to electronic medical records—for nearly 24 hours, according to a New York Times report, but there were enough paper records for doctors and nurses to treat their patients without any harm.

In the West, Verizon wireless customers often must rely on CenturyLink wiring to carry signals between cell towers, and those calls were impacted. And the Massachusetts Emergency Management Agency (MEMA) urged New Englanders to learn the 10-digit phone numbers of their local police departments due to sporadic 911 problems caused by the CenturyLink outage.

Implications for healthcare facilities

The recent outages show that even in today’s world of advanced telecommunications, things can go wrong, and they can affect operations at hospitals. Fortunately, most hospitals, as required by surveys, have backup plans to keep operational, but it certainly bears repeating some of the things that you should keep in mind when evaluating your system.

The biggest issues that hospitals in the New York area dealt with during Superstorm Sandy in 2012 were closed roads, as well as submerged basement generators that wiped out even the best backup plans.

While many contingencies are focused around weather disasters that can be prepared for ahead of time with some warning, emergency electrical planning should also take into consideration events that no one can see coming. Take, for example, the hospital in Virginia that had its entire basement flooded when a behavioral health patient locked himself in a room and proceeded to tear out all the room’s water pipes.

First, remember that CMS and most accreditation organizations require your facility to be able to remain functional for 96 hours after a major catastrophe. The reality is that in the most severe of cases, you may need to plan for longer. Many factors will go into your decisions, and a good assessment will help you get started.

FEMA designed a book that can help hospital engineers develop contingency plans to keep the power on when disaster strikes. The 170-page book, Emergency Power Systems for Critical Facilities: A Best Practices Approach to Improving Reliability, is also known as FEMA P-1019 in the industry and was completed in September 2014 and last updated in February 2015. Check out and download the entire publication.

Emergency generators

Many larger hospitals rely on large, on-site generators to help their hospitals remain powered in the event of a disaster, but for smaller facilities, having this redundancy permanently installed can be a prohibitive capital cost. Codes require that you have a redundancy plan in place—but that plan could just as well be a temporary generator that can be brought in before or during an event.

For this reason, some hospitals prefer to set their systems up so that a “quick connect” temporary generator can be rapidly set up and connected. This kind of setup doesn’t require constant testing and maintenance on your part, instead delegating the maintenance to outside vendors. However, this option does require forming relationships with outside vendors and making sure they are reliable during an emergency. FEMA recommends the following if you go with this option:

  • Maintain vehicle access. To get a generator into your hospital, there must be an open road that can handle a large truck with a huge load (at least 10,000 pounds). Assuming your generator is delivered after the event, at least one access route must be clear of fallen trees and not blocked by debris or other obstructions such as floodwater (these are all things to consider in your assessment). With this in mind, choosing this option might mean constructing paved roads or gravel roads on your site.
  • Create a location. During an emergency is not the time to figure out that you have no place to put a generator. Your plan should include a predetermined location to store the equipment, preferably close to where it will be electrically connected to the facility. Remember that long cable connections can cause a voltage drop, which can damage equipment, and installing more cables can be expensive. Concrete slabs can be placed to support generators, or designated parking areas can be assigned to site the trailers. (Keep in mind where fuel will be stored.) Lastly, try to locate generators in a way that doesn’t subject neighbors to loud noise.
  • Have a pre-installed connection. You’ll need to consider the types of cables needed when connecting your generator. Flexible cables are normally used to connect the temporary generator to a facility. For smaller installations (approximately 15kW single-phase or 25kW three-phase), a multi-conductor cable that terminates in a twist-lock receptacle is often used. The receptacle can connect to a mating plug mounted on the building. For larger generators, single conductor cables that terminate in slip-fit plugs and matching receptacles are typically used. Whatever you do, FEMA recommends that the method used to connect must prevent any power from being back-fed onto utility lines—to prevent injuries or death from shocks.
  • Establish vendor contracts ahead of time. Hospitals need to work with police and other public resources to help ensure that vendors can get through to resupply during disasters.

The reason is simple: During an emergency, vendors for fuel and other services will be busy, and it may be difficult or impossible for them 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 the hospital to take over the station’s inventory in the event of an emergency; others have bought their own tanker trucks to store fuel stocks during storms.

Best practices

If you’re concerned with staying on top of codes and regulations, and making sure your hospital can keep the power on and stay operational during an emergency scenario, where do you start?

ASHE says you should start with a good assessment of where you are now and suggests beginning with an emergency power supply system vulnerability assessment survey, available online from the California Hospital Association.

“Opportunities are presented that would allow hospitals to island from the grid through innovative power generating technologies that provide the added bene?t of covering more of a hospital’s critical functions on emergency power,” states the ASHE report. “As hospitals embrace these new technologies and innovative protocols, they can better protect patients and more fully serve the communities that depend on them during disasters.”

Among the questions you should address are the following:

  • In addition to conducting required testing on backup generators, do you routinely test switchgear equipment?
  • Do you have a service contract for your emergency power system?
  • Who are your primary and secondary service and fuel providers?
  • Have you identi?ed locations for temporary generator installations on your campus?
  • Does the hospital have a stock of recommended spare parts for its diesel generators or assurances from a local diesel distributor to provide spare parts?
  • Have appropriate personnel been trained on manual operation of the diesel generators or emergency system?
  • Does your emergency generator system have any unique cooling or operational requirements that may require special measures during a disaster (heat exchangers, cooling towers, etc.)?
  • Do you have a protocol for detaching and reattaching to your electric utility during power outages?
  • Does your hospital have plans to replace some or all of its generators within the next three to ?ve years?
  • Are there restrictions in place regarding which service companies are authorized to provide service to any of your generators, switchgear equipment, or automatic transfer switches?
  • Is your water system dependent on power for water pressure because of building elevation?
  • Is your wastewater system dependent on power for sewage ?ow away from your facility into local sewer or septic systems?
  • Are your generators and their components, including fuel tanks, above the ?oodplain and safe from other water surges such as dam and water tower breaks? If no, are system components encapsulated and protected from a ?ood?
  • Approximately how many years old are your generators?



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