Revisiting Disaster Preparedness

Posted on November 2, 2012


After a natural disaster like “Superstorm” / Hurricane Sandy, it makes perfect sense to examine if a company or institution has disaster planning protocol in place. Although Florida was mercifully spared the wrath of Sandy, hospitals here are once again revisiting the subject. Given the recent spate of hurricanes, tornadoes, and terrorist attacks, I am surprised by any organization without an exhaustive, well-defined, and well-practiced readiness plan. Does your hospital have one?

Recent articles on disaster planning best practices for healthcare have been penned as a result of the Joplin tornado event that leveled St. John’s in Joplin, MO. Many of what I have read focus on internal operations, so I will focus on two aspects of infrastructure with which your design-builder can directly assist.

On a micro-planning scale, two essential aspects of disaster readiness include energy to run the hospital, and how to handle an unexpected “surge”, or an unusually large influx of needy patients. The design of your facility has a direct bearing on the successful dealing of these two concerns.

First, energy to run a hospital is essential. Let me share some direct quotations from a roundtable discussion of nine healthcare facilities directors on emergency power from Medical Design + Construction’s Nov./Dec. 2011 issue (pp. 22-25):

“…our data center is located offsite from the hospital…our data center was in business occupancy.  As far as the data center itself, that would be classified as optional standby branch.  So now you’ve got medical records, which you would think would be critical branch or life safety branch or equipment branch [of Article 517 from the National Electric Code].”

“NEC Article 708 says I’ve got to keep my critical operations power systems running, and it also says in 708.22, for an unlimited number of hours.”

“Except, I don’t want to get the bodies out of the building.  I want to defend in place, because I’ve got several floors of people that [sic] can’t move…I can’t move them, so it’s not about getting them out of the building. It’s about keeping them.”

“I don’t think any code was developed for applicability over 72 hours, like the field capability of diesel generators.  Katrina lasted much longer and the horror stories that came out of some of the hospitals, wow.”

“One driver to add equipment is if you are the sole provider in a 200-square mile area, you do it.”

“Understanding the cost of not doing business and why we needed a fully redundant hospital is why I interviewed a surgical director.  I had no idea that from a lost-revenue perspective, for our hospital it was $17,000 per OR per hour…it really adds to the business case very rapidly.”

“To dovetail into what you were saying about the construction process…a lot of times maybe they [hospitals] cannot afford the second generator.  But it might make sense to provide room for it.”

There are no easy answers to the above issues, some of which are code-driven.  However, technology like cogenerated power may take a few of these concerns off the table.  Power generated on-site from natural gas, like cogen, is less likely to be interrupted, allowing a hospital to have ‘full’ backup power for a majority of its activities, not merely 72 hours for a small percentage of your hospital’s functions. By now, we have likely heard of NYC’s Bellevue Hospital, which is evacuating over 500 patients because its back-up generators failed.

When a storm hits, electricity is often lost, and 72 hours is not much of a safety net. Given the rest of the IT network needs, a more comprehensive disaster plan is prudent. Other industries have more than made the investment, and as stated above, redundancy is part of a business case argument to be operational for more than a few days without grid utilities.

The second aspect of disaster planning that can be accounted for in design is handling a surge of patients. A surge of patients can come from any mass casualty—natural disaster, auto accident, or pandemic to name a few. More poignantly, capacity at a hospital can be compromised for more than one reason:  patient surge, maintenance / construction, or just poor resource utilitzation.

However, there are tools to help hospitals 1) design more effective facilities prior to construction, and 2) better organize existing space to best handle adverse treatment situations.

The primary tool your design-builder can use is simulation. Simulation integrates well with performance initiatives already in place, like Lean or Six Sigma, and is a very visual tool that most clinicians can understand. This is crucial because it is the hospital’s actual information from its operations (in the lab, ORs, ER, etc.) that creates the 3D models used to generate data. Simulation output helps show, in a visual and data-driven way, “what happens if…”. It shows how things work now, and how they would work.  That way, every scenario can be explored virtually, without costing money or lives, and no scenario is a surprise—for instance, temporarily housing a crowd who shows up at a hospital after a storm.

Disasters already provide so much uncertainty to hospitals.  Given the clear effect on mission and business objectives, hospitals cannot plan too much, invest too much in knowing what to do, nor be too versed in execution—no matter what.