Lessons learned on 9-11 help hospitals respond to blackout

[NRSKarenRN, BSN, RN]

By CLIFFORD J. LEVY with KATE ZERNIKE

New York Times, Aug. 17, 2003

http://www.nytimes.com/2003/08/16/nyregion/16MEDI.html

Hospitals and other health care providers in regions affected by the blackout went on crisis footing yesterday, using backup generators to operate lifesaving equipment, activating plans that had been honed after the Sept. 11 terror attacks and treating an influx of patients suffering heat-related illnesses.

Administrators at many hospitals said that after they had canceled elective procedures, the generators allowed them to maintain power in intensive care units and emergency rooms so that few major problems arose. But some hospitals and nursing homes acknowledged that generators had broken or run out of fuel, forcing them to move patients or in a few instances evacuate them altogether.

Mount Sinai Medical Center in Manhattan, Coney Island Hospital in Brooklyn and Mary Immaculate Hospital in Queens reported significant troubles with their backup power, though they were eventually corrected, hospital administrators said.

Jamaica Hospital in Queens, which lost one of its two main backup generators for a time, took in patients on ventilators from a nursing home and at least three other hospitals that had even worse failures, said David P. Rosen, Jamaica's president.

Like other hospital administrators, Mr. Rosen said no one had died or been harmed because of a power loss. But offering an example of how his hospital had to improvise, he described how in order to draw enough power to perform a CAT scan on a patient transferred from Mary Immaculate, the hospital had to turn off some air-conditioning.

"Everybody is blowing generators," Mr. Rosen said. "I'm shocked at what I'm seeing. And I'm troubled. For all the yelling and screaming that everybody did after 9/11, there is nothing forthcoming to help us shore up this infrastructure."

Still, in general, administrators at most hospitals said they had working generators, though many did not have enough power for all their air-conditioners. In maternity wards and emergency rooms, patients sweated and staffs tried to cool them with cold washcloths and bags of ice.

Amy Lee, a spokeswoman for the American Hospital Association, which represents nearly 5,000 hospitals across the country, said an informal survey had shown that for the most part, hospitals had successfully put in place emergency plans.

Joseph F. Damore, the president of Sparrow Health Systems in Lansing, Mich., said its two hospitals immediately carried out what they call a code green plan when the power went out at 4:33 p.m. on Thursday.

Officials ordered a tanker of fuel to make sure that six generators would keep running. Sparrow's main 500-bed hospital, the chief trauma center serving central Michigan, called in extra staff. Forty fans were obtained from Home Depot. The fire department arrived to light the hospital's helipad so a young woman with an aneurysm could be transferred.

Like doctors at other facilities, the ones at the Sparrow hospitals were especially worried about respirators and monitors in intensive care units, because generator power can be erratic, causing delays or stalling the equipment.

No major trauma cases arrived, but as the blackout continued, the emergency room at the main Sparrow hospital swelled with patients suffering from breathing problems because of the heat and humidity. And as people took to their porches to drink, the hospital saw a high number of people suffering from alcohol poisoning, Mr. Damore said.

Nine patients were in labor when the power went out. Jennifer Gallo, 31, was one of them. Around 8 p.m. on Thursday, Christopher Rudy Gallo arrived into a sweltering room lighted only by one lamp.

Nurses had cooled his mother with washcloths, scrambled to find flashlights, and opened windows until bugs began flying in.

"I just had a taste of what my grandmother was like with her deliveries, a hot summer and no epidural," Ms. Gallo said.

At the 650-bed Henry Ford Hospital in Detroit, the biggest problem was water, with the blackout shutting off the main supply. The hospital brought in bottled water for drinking, to sanitize equipment and even to fill a therapeutic pool used for cleaning patients.

At Blythedale Children's Hospital in Valhalla, N.Y., the generator failed an hour and a half after the power went out, prompting the transfer of 18 children on ventilators to two nearby hospitals.

The generator was fixed while the children were being readied to go, but Blythedale's president, Larry Levine, said the hospital decided to transfer them anyway. By yesterday afternoon, with the power restored, all the children had returned.

At many hospitals in New York City, lessons learned on Sept 11 were put to their first real test. One of them was that in the early hours of a crisis, there may be too many staff members present, not too few, because doctors and other workers not on duty reflexively head toward a hospital or stay after their shifts.

"The fact is, when these things happen, we have more people around than we need," said Dr. Richard F. Daines, president of the St. Luke's-Roosevelt Hospital Center in Manhattan.

To assign staff more efficiently, Roosevelt now maintains an inventory showing who lives where, in concentric circles radiating from the hospital. And to limit the number of staff members in the emergency room, orange vests are issued to authorized personnel. The main entrance is closed and arrivals are funneled through the ambulance bay.

All in all, the transition this time went smoothly, said Dr. Daines, crediting the extra preparedness born of the terrorist attack. "We did a tabletop drill on a smallpox outbreak," he said Thursday night, "so this seems pretty small."

[NRSKarenRN, BSN, RN]

Cleveland hospitals relied on emergency systems, staff in blackout

Cleveland hospitals affected by last week's massive blackout relied on emergency power systems to stay open and to keep their most critically ill patients alive.

Cleveland Plain Dealer, Aug. 20, 2003

http://www.cleveland.com/blackout/index.ssf?/base/news/1061372194123260.xml

[oramar]

It is great how everyone pulled together. But it sounds kinda rickity. What if this went on for weeks or months instead of days?