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Utility Failures
Topic Collection
January 13, 2023

Topic Collection: Utility Failures

Losing power or potable water after a critical incident can have serious and significant effects on both healthcare facilities and patients. Either situation could lead to facility evacuation, as the utilities are significantly interdependent within healthcare facilities. (Access the ASPR TRACIE Healthcare Facility Evacuation/Sheltering Topic Collection for more information on this topic.) The resources in this Topic Collection include lessons learned from recent disasters, case studies, and toolkits designed to help healthcare planners prepare to respond to, continue functioning during, and recover from post-disaster utility failures.

Planners may also wish to access several other related ASPR TRACIE Topic Collections. The Access and Functional Needs Topic Collection highlights recent case studies, lessons learned, tools, and promising practices for working with individuals with disabilities and others with access and functional needs. For information on planning for and treating patients with kidney disease during and after a disaster, access the Dialysis Center Topic Collection. The Continuity of Operations (COOP) Failure Plan Topic Collection also contains helpful resources.

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.


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Must Reads

Anderson, G. and Bell, M. (2012). Lights Out: Impact of the August 2003 Power Outage on Mortality in New York, NY. Epidemiology. 23(2): 189-193.
The authors examined the effect of a large U.S. blackout (2003, New York) on mortality. They found a 122% increase in accidental deaths, a 25% increase in non-accidental deaths, but their estimates of mortality risk exceeded actual reported mortality.
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ASPR TRACIE. (2021). Durable Medical Equipment in Disasters.
This ASPR TRACIE tip sheet provides information on general durable medical equipment (DME) categories and focuses on electricity-dependent DME that may be affected by disasters and emergencies, including power failures. It also includes information to assist healthcare system preparedness stakeholders plan for populations who rely on DME.
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ASPR TRACIE. (2021). Managing the Storm After the Storm: Healthcare in TX Recovers from Severe Winter Weather.
Michael Wargo (HCA Healthcare), Scott Cormier (Medxcel), and Toni Carnie (HCA Houston Healthcare Tomball) share how a rare winter storm, extreme cold, and unplanned power outages affected utilities--particularly water and water pressure--in healthcare facilities throughout Texas. This summary highlights issues that will benefit from additional mitigation and preparedness activities as extreme weather incidents increase in frequency.
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California Emergency Medical Services Authority. (2017). Incident Planning Guide: Utility Failure.
This document includes a series of questions to guide hospitals in planning for utility failures associated with systems such as power, water, heating, ventilation, air conditioning, medical air, vacuum, or medical gases.
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California Hospital Association. (n.d.). Loss of Utilities/Services. (Accessed 6/29/2021.)
This webpage includes links to many resources related to healthcare facilities preparing for and responding to utility outages. There are links to presentations, tools categorized by utility system, best practices, and lessons learned.
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Centers for Disease Control and Prevention. (2014). Power Outages.
This webpage includes links to general informational resources related to power outages and resources specific to worker safety and healthcare facilities.
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Centers for Disease Control and Prevention. (2019). Emergency Water Supply Planning Guide for Hospitals and Health Care Facilities.
This comprehensive document provides a four-step process for the development of a hospital emergency water supply plan and includes tips for assembling the right planning team, performing a water use audit, analyzing alternatives, and developing and exercising the plan.
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  • Rodney Merritt Onsite Water Management can prevent Hospital water outages.
    9/23/2020 2:27:58 PM
Federal Emergency Management Agency, Office of the Assistant Secretary for Preparedness and Response. (2019). Healthcare Facilities and Power Outages: Guidance for State, Local, Tribal, Territorial, and Private Sector Partners. U.S. Department of Homeland Security; U.S. Department of Health and Human Services.
The guidance in this document can help state, local, tribal, and territorial governments, first responders, utility companies, and healthcare facilities improve facility preparedness; understand how to "integrate emergency preparedness efforts throughout the whole community;" and prioritize assistance to healthcare facilities during power outages.
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Healthcare & Public Health Sector Coordinating Councils. (n.d.). Planning for Power Outages: A Guide for Hospitals and Healthcare Facilities. (Accessed 6/29/2021.) U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This checklist can help emergency planners prepare for and respond to power outages in their facilities.
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Healthcare & Public Health Sector Coordinating Councils. (n.d.). Working Without Technology: How Hospitals and Healthcare Organizations Can Manage Communication Failure. (Accessed 6/29/2021.) U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This fact sheet summarizes steps a healthcare facility can take to ensure communication during incident response when normal technologies fail.
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HHS emPOWER Program. (2020). HHS emPOWER Quick Data Reference Guide.
The HHS emPOWER Map, emPOWER AI, HHS emPOWER REST Service, and HHS emPOWER Emergency Planning De-identified Dataset (authorized public health authorities only) provide monthly de-identified totals of Medicare claims submitted for reimbursement for certain electricity-dependent durable medical and assistive equipment (DME) and devices. The HHS emPOWER Emergency Planning De-identified Dataset also provides more detailed de-identified data, including Medicare claims data totals for four types of health care services. The HHS emPOWER Quick Data Reference Guide provides detailed information about these DME, devices, and health care services.
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Klinger, C., Landeg, O., and Murray, V. (2014). Power Outages, Extreme Events and Health: A Systematic Review of the Literature from 2011-2012.
The authors identified 20 articles that examined the effects of power outages on health. Table 5 highlights the impacts by category (e.g., hospital, healthcare, community, and public health infrastructure).
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Minghella, L. (2013). Be Prepared: Lessons from an Extended Outage of a Hospital's EHR System.
The author shares her experience losing access to her facility's electronic health record system for ten days following a power outage.
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Stoto, M., Piltch-Loeb, R., and Savoia, E. (2015). The Public Health System Response to the 2014 West Virginia Water Crisis.
The authors analyzed the public health system’s response to the spill of close to 10,000 gallons of a chemical cleaning agent into West Virginia's Elk River, a public water supply to nine counties in the state. They focused specifically on internal and external (risk) communication with the public.
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Stymiest, D. (2016). Best Practices for Hospital Power System Reliability.
The author lists best practices for healthcare facility planners to consider regarding preventing, preparing for, and responding to power outages.
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Education and Training

Centers for Medicare & Medicaid Services. (2022). Replacing DME & Prescription Drugs after a Disaster: Addressing the Needs of Medicare Beneficiaries. U.S. Department of Health and Human Services.
This training discusses access to durable medical equipment and prescription drugs after a disaster. It provides information on prescription drug programs through Medicare during recovery and contact information for the Centers for Medicare & Medicaid Services. In the description, it also contains links to current Medicare information since policies can change. The full report is also available: https://www.cms.gov/files/document/replacing-dme-and-prescription-drugs-after-disaster-student-manual.pdf
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Federal Emergency Management Agency. (2016). IS-815: ABCs of Temporary Emergency Power.
This course can help emergency planners and responders understand the requirements associated with providing temporary generator power to facilities.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2019). HHS emPOWER Program Web-Based Training. (Free account required.)
The HHS emPOWER Program Web-Based Training is a free, publicly accessible course designed to help partners better understand the HHS emPOWER Program and integrate its tools into their emergency preparedness, response, recovery, and mitigation activities.
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Virginia Department of Public Health. (2013). Don't Sweat It: Preparing for Disasters in Nursing Homes and Assisted Living Facilities.
This video was developed to be an educational tool for staff training on emergency preparedness specific to long-term care facilities. The scenario follows staff as they deal with a major storm that causes a week-long power outage. The video covers topics including preparedness, sheltering in place, and evacuation.
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Guidance

ASPR TRACIE. (2021). Durable Medical Equipment in Disasters.
This ASPR TRACIE tip sheet provides information on general durable medical equipment (DME) categories and focuses on electricity-dependent DME that may be affected by disasters and emergencies, including power failures. It also includes information to assist healthcare system preparedness stakeholders plan for populations who rely on DME.
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Baker, G.H. and Volandt, S. (2018). Cascading Consequences: Electrical Grid Critical Infrastructure Vulnerability. Domestic Preparedness.
This article provides an overview of the national power grid, and related threats (e.g., coordinated physical attacks, cyber-attacks against industrial control systems, electromagnetic pulse denotation, and severe solar storms). The authors examine risks, threats, impacts, current state of preparedness, and conclude with recommendations to enhance critical infrastructure resilience.
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* California Hospital Association. (n.d.). Loss of Utilities/Services. (Accessed 6/29/2021.)
This webpage includes links to many resources related to healthcare facilities preparing for and responding to utility outages. There are links to presentations, tools categorized by utility system, best practices, and lessons learned.
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Centers for Disease Control and Prevention. (2014). Clinical Guidance for Carbon Monoxide (CO) Poisoning After a Disaster.
This guidance can help healthcare providers determine whether patients are suffering from carbon monoxide poisoning (more likely to be an issue after a power outage, when residents are using generators).
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Centers for Disease Control and Prevention. (2014). Impact of Power Outages on Vaccine Storage.
This resource provides tips on maintaining the integrity of vaccine supplies during a power outage.
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Centers for Disease Control and Prevention. (2014). Power Outages.
This webpage includes links to general informational resources related to power outages and resources specific to worker safety and healthcare facilities.
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Choose Energy. (2019). Electricity Emergency Preparedness for Senior Citizens and their Caretakers.
The guidance on this web page can help older adults and their caretakers plan for, respond to, and recover from power outages.
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Electromagnetic Pulse Special Interest Group. (2017). Resilient Hospitals Handbook: Strengthening Healthcare and Public Health Resilience in Advance of a Prolonged and Widespread Power Outage.
This document can help healthcare facility managers and planners increase resilience, plan for extended power outages, and create and store enough power on-site to operate in "island mode" for a prolonged period of time without outside sources of power or fuel. It outlines challenges and opportunities to solve a number of high-impact threats to critical infrastructure that can result in a regional or nationwide months-long power outage, making it unlikely for timely outside help to arrive.
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Federal Emergency Management Agency, Office of the Assistant Secretary for Preparedness and Response. (2019). Healthcare Facilities and Power Outages: Guidance for State, Local, Tribal, Territorial, and Private Sector Partners. U.S. Department of Homeland Security; U.S. Department of Health and Human Services.
The guidance in this document can help state, local, tribal, and territorial governments, first responders, utility companies, and healthcare facilities improve facility preparedness; understand how to "integrate emergency preparedness efforts throughout the whole community;" and prioritize assistance to healthcare facilities during power outages.
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Healthcare & Public Health Sector Coordinating Councils. (n.d.). Working Without Technology: How Hospitals and Healthcare Organizations Can Manage Communication Failure. (Accessed 6/29/2021.) U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This fact sheet summarizes steps a healthcare facility can take to ensure communication during incident response when normal technologies fail.
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Healthcare & Public Health Sector Coordinating Councils. (2014). Planning for Water Supply Interruptions: A Guide for Hospitals & Healthcare Facilities. (Accessed 6/29/2021.) U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This information sheet highlights some of the impacts of a water interruption and poses questions to ask to help facilities prepare for an interruption. Additionally, it provides information on existing resources that can help facilities develop and implement their preparedness strategy, including information related to the Joint Commission Emergency Management Standards for hospitals to have a plan to respond to a 96-hour denial of service for all utilities, including water and wastewater services.
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HHS emPOWER Program. (2020). HHS emPOWER Quick Data Reference Guide.
The HHS emPOWER Map, emPOWER AI, HHS emPOWER REST Service, and HHS emPOWER Emergency Planning De-identified Dataset (authorized public health authorities only) provide monthly de-identified totals of Medicare claims submitted for reimbursement for certain electricity-dependent durable medical and assistive equipment (DME) and devices. The HHS emPOWER Emergency Planning De-identified Dataset also provides more detailed de-identified data, including Medicare claims data totals for four types of health care services. The HHS emPOWER Quick Data Reference Guide provides detailed information about these DME, devices, and health care services.
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* Karfunkle, M. (2018). Safeguarding the Cold Chain with Solar Power. U.S Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
While solar panels alone can’t power a larger facility, small facilities like health posts can run entirely on solar power with batteries, and many critical systems in a larger facility like a clinic or hospital can run independently from the facility’s power lines as modular, electrically isolated systems. This presentation explains the "cold chain" process in healthcare, illustrates the requirements of a solar vaccine refrigerator, and shows users how to use NASA data to calculate insolation (amount of solar energy per unit area per day that hits an area).
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* Manto, C., Motzer, E., and Terbush, J.. (2017). Resilient Hospitals Handbook: Strengthening Healthcare and Public Health Resilience in Advance of a Prolonged and Widespread Power Outage.
This handbook can help healthcare facility managers and planners increase resilience, plan for extended power outages, and create and store enough power on-site to operate in "island mode" for a prolonged period of time without outside sources of power or fuel.
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New York City Department of Health and Mental Hygiene. (2020). Disaster Preparedness for Children with Disabilities: Durable Medical Equipment.
This document (available in a variety of languages) was created to help people caring for a child with a disability make better informed decisions about the child’s health and safety, and support the implementation of public-private collaborations in communities during a disaster.
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Powered for Patients. (2020). Protecting Patients When the Power Goes Out: Phase I Report of the Los Angeles County EMS Agency’s Emergency Power Resilience Initiative.
This report describes Phase 1 of a joint project between Los Angeles County Emergency Medical Services Agency and Powered for Patients. The gap assessment was conducted to evaluate the current process used by critical healthcare facilities to report threats to emergency power during a power outage and the response to such reports by government officials and utilities. Key findings and recommendations are highlighted throughout the document and summarized at the end.
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Roberson, A.J. and Hiltebrand, D.. (2010). Emergency Water Supply Planning, Part 1: Hospitals and Health Care Facilities. (Free registration required.) American Water Works Association. 102(5): 36, 38, 40.
The authors of this article discuss the impact of water supply loss on hospitals and other health care facilities. They also address the Centers for Disease Control and Prevention and American Water Works Association’s "Emergency Water Supply Planning Guide for Hospitals and Health Care Facilities" document (provided above) and note the goal of this project was to provide guidance for health care facilities in evaluating their water use and determining how it might be curtailed in an emergency, and in developing an emergency water supply plan for the facility.
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Salfarlie, W. (2012). ‘Code Blue.’ Planning and Managing Emergency Water Systems. Health Facilities Management.
The author of this article addresses the planning process for hospital’s emergency water supply, and further breaks it into planning for existing hospitals and for new construction.
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Stymiest, D. (2015). How to Plan for Water Outages. Health Facilities Management.
The author lists best practices for healthcare facility planners to consider regarding preventing, preparing for, and responding to water outages.
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Stymiest, D. (2016). Best Practices for Hospital Power System Reliability.
The author lists best practices for healthcare facility planners to consider regarding preventing, preparing for, and responding to power outages.
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Tincher, L. (2018). CMS Begins Enforcement of New Rule to Bolster Emergency Preparedness. Nutrition & Food Service EDGE.
The author provides an overview of recent disasters and the Centers for Medicare & Medicaid Services Emergency Preparedness Rule. The rest of the article highlights lessons learned and emphasizes the importance of healthcare facility emergency food planning (e.g., storing and documenting inventory) and having Memoranda of Understanding specific to the delivery of food, water, and supplies.
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Transportation and Infrastructure Committee, U.S. House of Representatives. (2016). Blackout! Are We Prepared to Manage the Aftermath of a Cyber-Attack or Other Failure of the Electrical Grid?
This two-hour hearing of the Subcommittee on Economic Development, Public Buildings, and Emergency Management features experts in prolonged, widespread power outages discussing vulnerabilities, preparedness, and response.
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2019). The Department of Health and Human Services emPOWER Program: emPOWERing Communities Through New Practical Applications, Training, Informational Resources, Toolkits, Maps, and Virtual Assistants.
The first speaker provided an overview of emPOWER and highlighted new data, tools, and resources. Subsequent speakers (from Los Angeles County and the Virginia Department of Health) shared their experiences using the tool.
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U.S. Environmental Protection Agency. (2011). Planning for an Emergency Drinking Water Supply.
This document addresses the supply of drinking water after a disaster. Five workshops were convened with approximately sixty technical experts who reviewed alternative means of providing drinking water in the event of destruction, impairment, or contamination of the public water supply.
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U.S. Food and Drug Administration. (2015). Medical Devices Requiring Refrigeration.
Tips for storing common medical devices and other products during and after a power outage are listed on this webpage.
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U.S. Food and Drug Administration. (2018). Disposal of Contaminated Devices.
This resource provides tips on checking medical devices for contamination and disposing of contaminated products in order to help pharmacies return to business as soon as possible following flooding or loss of power.
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Williams, M. (2016). Healthy Energy: Creating Outage-Resilient Hospital Facilities. Healthcare Facilities Today.
In this blog post, the author explains the "Energy Network of Things" concept and how it can contribute to a healthcare facility's resilience in a power outage.
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Lessons Learned

Abir, M., Jan, S., Jubelt, L., et al. (2013). The Impact of a Large-Scale Power Outage on Hemodialysis Center Operations. Prehospital and Disaster Medicine. 28(6): 543-6.
The authors examined how power outages in Washington, DC, and five counties in West Virginia and Maryland impacted operations in a sample of 36 hemodialysis centers. They found that those with pre-existing plans, including provisions for back-up generators and referral agreements with other dialysis centers, offered continuity of care to their patients.
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Anderson, G. and Bell, M. (2012). Lights Out: Impact of the August 2003 Power Outage on Mortality in New York, NY. Epidemiology. 23(2): 189-193.
The authors examined the effect of a large U.S. blackout (2003, New York) on mortality. They found a 122% increase in accidental deaths, a 25% increase in non-accidental deaths, but their estimates of mortality risk exceeded actual reported mortality.
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ASPR TRACIE. (2021). Managing the Storm After the Storm: Healthcare in TX Recovers from Severe Winter Weather.
Michael Wargo (HCA Healthcare), Scott Cormier (Medxcel), and Toni Carnie (HCA Houston Healthcare Tomball) share how a rare winter storm, extreme cold, and unplanned power outages affected utilities--particularly water and water pressure--in healthcare facilities throughout Texas. This summary highlights issues that will benefit from additional mitigation and preparedness activities as extreme weather incidents increase in frequency.
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Barkemeyer, B. (2006). Practicing Neonatology in a Blackout: The University Hospital NICU in the Midst of Hurricane Katrina: Caring for Children Without Power or Water. Pediatrics. 117(Suppl. 4):S369 -S374.
The author recounts the challenges associated with providing care in a university hospital’s neonatal intensive care unit before, during, and after Hurricane Katrina made landfall.
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* California Hospital Association. (n.d.). Loss of Utilities/Services. (Accessed 6/29/2021.)
This webpage includes links to many resources related to healthcare facilities preparing for and responding to utility outages. There are links to presentations, tools categorized by utility system, best practices, and lessons learned.
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Casey, J., Mango, M., Mullendore, S., et al.. (2021). Trends from 2008–2018 in Electricity-Dependent Durable Medical Equipment Rentals and Sociodemographic Disparities. Epidemiology. 32(3): 327–335.
The authors used Kaiser Permanente South California electronic health record data to calculate annual prevalence of equipment rental, then stratified it by rental of breast pumps or other equipment. Their findings "suggest that energy access is increasingly critical in meeting the health needs of medically disadvantaged groups" and the need will only increase as the number of disaster-related power outages increases.
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Centers for Disease Control and Prevention. (2017). Healthcare Water System Repair and Recovery Following a Boil Water Alert or Disruption of Water Supply.
This webpage discusses infection control recommendations for use during a boil water alert, as well as recovery actions to take after the boil water alert is lifted. There is also a section specific to sterile processing, which provides the requirements by the CDC and the Association for the Advancement of Medical Instrumentation (AAMI).
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Cote, E. (2021). Case Study: Generator Failure During Power Outage following Hurricane Isaias Underscores Heightened Risk to Patients in Single Generator Facilities.
This article provides a timeline of events and lists lessons learned and promising practices based on a hurricane-related power outage at a skilled nursing facility.
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Femino, M., Young, S., and Smith, V. (2013). Hospital-Based Emergency Preparedness: Evacuation of the Neonatal Intensive Care Unit-The Smallest and Most Vulnerable Population. (Abstract only.) Pediatric Emergency Care. 29(1):107-13.
The authors describe a full-scale neonatal intensive care unit evacuation exercise and emphasize the importance of constant, clear communication.
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Fink, S. (2013). Five Days at Memorial: Life and Death in a Storm-Ravaged Hospital. (Book available for purchase.)
The author details the consequences of Hurricane Katrina on Memorial Hospital in New Orleans. This book—a critical “call to action”—offers learning about the consequences of utilities failures and the importance of incident management, communication, and healthcare coalition connections between hospitals, community emergency medical systems, and emergency management during such incidents and why crisis care processes must be integrated into the incident command system.
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Greenwald, P., Rutherford, A., Green, R. et. al. (2004). Emergency Department Visits for Home Medical Device Failure During the 2003 North American Blackout. Academic Emergency Medicine. 11(7):786-789.
The authors assessed the characteristics of community-based medical device dependent individuals that rapidly sought assistance in the emergency department during the Northeast Blackout of 2003. The study sought to characterize the population and identify specific emergency planning scenarios and resources that could inform planning and response activities in any future emergencies or disasters.
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HHS emPOWER Program. (2020). Stories from the Field: Blizzards in Goshen County, Wyoming.
During back-to-back severe blizzards, Goshen County, Wyoming, used the emPOWER Emergency Response Outreach Individual Dataset, along with local electric cooperative and company information, to identify at-risk individuals in areas impacted by prolonged power outages. The county then partnered with the Sheriff’s Office to conduct approximately 25 targeted outreach phone calls and visits to the residences of at-risk individuals without cell phones.
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HHS emPOWER Program. (2020). Stories from the Field: Wildfires in Los Angeles County, California.
During severe wildfires, Los Angeles County, California, used the emPOWER Emergency Response Outreach Individual Dataset to identify and contact 38 local durable medical equipment and oxygen suppliers serving approximately 600 at-risk individuals to provide information on recovery resources for their clients. LA County also developed a formal multi-agency LA County-City of LA protocol that rapidly operationalizes data and supports integrated situational awareness, decision-making and action prior to, during, and after an emergency.
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Johnson-Arbor, K., Quental, A., and Li, D. (2014). A Comparison of Carbon Monoxide Exposures after Snowstorms and Power Outages. American Journal of Preventive Medicine. 46(5): 481-486.
The authors reviewed all carbon monoxide cases reported to the Connecticut Poison Control to better understand the difference between exposure after a snowstorm and exposure after a "power loss storm." They found most exposure took place within the first day after a snowstorm and two to three days after the power outage storm.
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* Karfunkle, M. (2018). Safeguarding the Cold Chain with Solar Power. U.S Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
While solar panels alone can’t power a larger facility, small facilities like health posts can run entirely on solar power with batteries, and many critical systems in a larger facility like a clinic or hospital can run independently from the facility’s power lines as modular, electrically isolated systems. This presentation explains the "cold chain" process in healthcare, illustrates the requirements of a solar vaccine refrigerator, and shows users how to use NASA data to calculate insolation (amount of solar energy per unit area per day that hits an area).
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Kearns, R., Wigal, M., Fernandez, A., et al. (2014). The 2012 Derecho: Emergency Medical Services and Hospital Response.. Prehospital and Disaster Medicine. 29(5): 542-545.
This article describes the use of Emergency Medical Services (EMS) and hospital resources in West Virginia in response to the 2012 derecho that resulted in substantial power outages.
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Klein, K., Rosenthal, M., Klausner, H. (2005). Blackout 2003: Preparedness and Lessons Learned from the Perspectives of Four Hospitals. Prehospital and Disaster Medicine. 20(5):343-49.
The authors reviewed after-action reports from four hospitals that experienced loss of power (and in two cities, water supply). They found that many issues landing or keeping patients in the hospital were social/resource rather than medical, which is consistent with more recent disasters (e.g., Hurricane Sandy).
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Klinger, C., Landeg, O., and Murray, V. (2014). Power Outages, Extreme Events and Health: A Systematic Review of the Literature from 2011-2012.
The authors identified 20 articles that examined the effects of power outages on health. Table 5 highlights the impacts by category (e.g., hospital, healthcare, community, and public health infrastructure).
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* Manto, C., Motzer, E., and Terbush, J.. (2017). Resilient Hospitals Handbook: Strengthening Healthcare and Public Health Resilience in Advance of a Prolonged and Widespread Power Outage.
This handbook can help healthcare facility managers and planners increase resilience, plan for extended power outages, and create and store enough power on-site to operate in "island mode" for a prolonged period of time without outside sources of power or fuel.
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Minghella, L. (2013). Be Prepared: Lessons from an Extended Outage of a Hospital's EHR System.
The author shares her experience losing access to her facility's electronic health record system for ten days following a power outage.
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Muscatiello, N., Babcock, G., Jones, R., et al. (2010). Hospital Emergency Department Visits for Carbon Monoxide Poisoning Following an October 2006 Snowstorm in Western New York. Journal of Environmental Health. 72(6): 43-48.
The authors conducted telephone interviews with a subset of people who were diagnosed with carbon monoxide poisoning after winter storm-related power outages in 2006.
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Present, D., Clair, J., Belyaev, S., et al. (2005). Effects of the August 2003 Blackout on the New York City Healthcare Delivery System: A Lesson for Disaster Preparedness. (Abstract only.) Critical Care Medicine, 33 (1): S96-S101.
The authors reviewed citywide emergency medical calls for service, emergency department visits, and hospital admissions after the 2003 power failure in New York City. They found unexpected increases in calls for service from respiratory device failures in community-based patients and note the need for better disaster preparedness planning for facilities and homebound patients.
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Shelton, S., Hamm, J., Olatosi, B., and Ory Johnson, R. (2018). Recovery of Surgical Equipment Sterile Processing During a Floodwater Boil Advisory. (Abstract only.) Disaster Medicine and Public Health Preparedness.
The authors of this article discuss the challenges faced in recovering their sterile processing for surgical equipment after floodwater contaminated their public water supply. They provide considerations for recovery plans, such as including a potable water source and a method to connect it to a required location.
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St. Dominic's Hospital. (2022). 2022 Jackson Water Crisis Response Summary.
This short article describes how the lessons incorporated by staff at St. Dominic's Hospital after Hurricane Katrina helped mitigate risks to the hospital's well-fed water system. These improvements and the support provided to hospital staff (e.g., providing showers, bottled waters, and other supplies) helped ensure that the hospital was able to continue to provide patient care and maintain operations during the 2022 Pearl River flooding event..
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Stoto, M., Piltch-Loeb, R., and Savoia, E. (2015). The Public Health System Response to the 2014 West Virginia Water Crisis.
The authors analyzed the public health system’s response to the spill of close to 10,000 gallons of a chemical cleaning agent into West Virginia's Elk River, a public water supply to nine counties in the state. They focused specifically on internal and external (risk) communication with the public.
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Tonn, G., Guikema, S., Ferreira, C., and Quiring, S. (2016). Hurricane Isaac: A Longitudinal Analysis of Storm Characteristics and Power Outage Risk. (Abstract only.) Risk Analysis. 36(10): 1936-1947.
The authors collected and analyzed hourly power data outage for Louisiana and examined the correlations between outages and storm conditions (wind, rainfall, and storm surge). In the case of Hurricane Isaac, the authors found that wind speed, precipitation, and previous outages had a stronger relationship with outages (storm surge had a weaker relationship, even in areas where storm surge was significant).
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* U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2019). The Department of Health and Human Services emPOWER Program: emPOWERing Communities Through New Practical Applications, Training, Informational Resources, Toolkits, Maps, and Virtual Assistants.
The first speaker provided an overview of emPOWER and highlighted new data, tools, and resources. Subsequent speakers (from Los Angeles County and the Virginia Department of Health) shared their experiences using the tool.
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Vugrin, E.D., Verzi, S.J., Finley, P.D., et al. (2015). Modeling Evacuation of a Hospital without Electric Power. Prehospital and Disaster Medicine. 30(3):279-87.
The authors of this report describe a modeling case study of the 2001 evacuation of the Memorial Hermann Hospital in Houston, Texas. They used a model designed to track cascading events following loss of infrastructure services and to identify the staff, resources, and operational adaptations required to sustain patient care and/or conduct an evacuation.
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Plans, Tools, and Templates

California Emergency Medical Services Authority. (2017). Incident Planning Guide: Utility Failure.
This document includes a series of questions to guide hospitals in planning for utility failures associated with systems such as power, water, heating, ventilation, air conditioning, medical air, vacuum, or medical gases.
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* California Hospital Association. (n.d.). Loss of Utilities/Services. (Accessed 6/29/2021.)
This webpage includes links to many resources related to healthcare facilities preparing for and responding to utility outages. There are links to presentations, tools categorized by utility system, best practices, and lessons learned.
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Centers for Disease Control and Prevention. (2019). Emergency Water Supply Planning Guide for Hospitals and Health Care Facilities.
This comprehensive document provides a four-step process for the development of a hospital emergency water supply plan and includes tips for assembling the right planning team, performing a water use audit, analyzing alternatives, and developing and exercising the plan.
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  • Rodney Merritt Onsite Water Management can prevent Hospital water outages.
    9/23/2020 2:27:58 PM
Healthcare & Public Health Sector Coordinating Councils. (n.d.). Planning for Power Outages: A Guide for Hospitals and Healthcare Facilities. (Accessed 6/29/2021.) U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This checklist can help emergency planners prepare for and respond to power outages in their facilities.
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HHS emPOWER Program. (2020). HHS emPOWER Map.
The HHS emPOWER Map provides monthly de-identified totals of Medicare claims submitted for one or more of the fourteen types of life-maintaining or saving electricity-dependent durable medical and assistive equipment (DME) and certain implanted electricity-dependent cardiac devices, at the national, state, territory, county, and ZIP Code levels. Users have the ability to create unique aggregations by geography and export the data, as well as the ability to access historical HHS emPOWER Map datasets for further analysis. When combined with real-time severe weather and hazard maps, the HHS emPOWER Map gives communities the power to anticipate, plan for, and address the needs of this population prior to, during, and after an incident, emergency, or disaster.
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MedStar Washington Hospital Center. (2018). Emergency Operations Plan: Central Sterilization System Outage. (Contact ASPR TRACIE for access to this document.)
This document provides a framework for the Central Sterilization staff and Hospital Incident Management Team to follow when the hospital’s system becomes inoperable due to power failure, water outage or contamination, equipment failure, limited staffing, or if the system is expected to be out of service for longer than two hours.
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  • Alex Lichtenstein Is it possible to have this attachment uploaded as a resource? I am unable to find it via the search mechanism. Thank you!
    6/5/2019 3:38:19 PM
Novation. (n.d.). Emergency Disaster Plan Template. (Accessed 6/29/2021.)
Healthcare facility emergency planners can use this template when developing their emergency operations plan. It features 12 disaster scenarios, including: hurricane, tornadoes, structure fires, earthquakes, and extreme cold.
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Spectrum Health. (n.d.). 96 Hour Operations Impact Chart. (Accessed 6/29/2021.)
This chart can help healthcare facility staff plan responses for various types of outages (e.g., gas, electric, water). The second table indicates estimated time frames for activating agreements and rebooting systems.
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Spectrum Health. (n.d.). Risk Ranking Emergency Outlets. (Accessed 6/29/2021.)
This Excel spreadsheet can help medical facility planners prioritize and calculate a "risk rank" for electrical outlets during an outage.
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Stymiest, D. (2008). Taking Care of Business – How Hospital Electrical Shutdowns Can Facilitate Emergency Management.
The author shares a comprehensive approach to managing hospital electrical power shutdowns in light of the increasing complexity of hospital infrastructures and operational constraints. He illustrates how using an electrical "shutdown" as a pre-planned and scheduled exercise can help train staff; sample shutdown resources are included in the appendices.
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U.S. Army Corps of Engineers. (2015). The Emergency Power Facility Assessment Tool. (Users must register for free and create profile.)
Healthcare and other critical infrastructure organizations can enter and store the information regarding their respective critical public facility generator requirements (along with required connection materials) into this online tool. The data is stored in a protected database and can help expedite delivery and installation of generators at prioritized and approved facilities during emergencies or disasters where commercial power is unavailable. This web site also offers facilities a permanent storage location and the ability to update the information as facility requirements change.
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U.S. Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response. (2021). Healthcare and Public Health (HPH) Risk Identification and Site Criticality (RISC) Toolkit.
This objective, data-driven all hazards risk assessment can be used to inform emergency preparedness planning and risk management activities. The toolkit consists of three self-assessment modules allowing healthcare facilities to: identify site-specific threats and hazards; assess site-specific vulnerabilities; and evaluate criticality and consequences. (A related webinar explains the toolkit in more detail: https://files.asprtracie.hhs.gov/documents/aspr-risc-toolkit-webinar-slides-final-508.pdf.)
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  • Tony Barker Great tool that has very effective resource links. Makes the HVA process evidence based and provides an excellent format for use. Thank you to the development team!
    12/12/2018 12:56:36 PM

Agencies and Organizations

California Hospital Association. Loss of Utilities/Services.
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Centers for Disease Control and Prevention. Power Outages.
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HHS emPOWER Program. HHS emPOWER Map.
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This ASPR TRACIE Topic Collection was comprehensively reviewed in January 2017 by the following subject matter experts (listed alphabetically):

Eric Alberts, CEM, CHS-V, FPEM, FPEM-HC, CDP-1, CHPP, CHEP, SEM, CFRP, FABCHS, Emergency Preparedness Manager, Orlando Health, Inc.; Julie Bulson, DNP, MPA, RN, NE-BC, Director, Emergency Preparedness, Spectrum Health; Kristen Finne, Program Manager, HHS emPOWER Initiative, Senior Policy Analyst, HHS/ASPR/OPP/Division of Healthcare System Policy; Michael Gurnick, Chair, Ashland Branch, Massachusetts Medical Reserve Corps, Region 4A and NACCHO MRC Workgroup; John Hick, MD, HHS ASPR and Hennepin County Medical Center; Brad Learn, Emergency Preparedness Coordinator, Kentucky Hospital Association; and Mary Russell, EdD, MSN, Emergency Services, Boca Raton Regional Hospital. 

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