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.
Must Reads
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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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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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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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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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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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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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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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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This checklist can help emergency planners prepare for and respond to power outages in their facilities.
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This fact sheet summarizes steps a healthcare facility can take to ensure communication during incident response when normal technologies fail.
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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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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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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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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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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
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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This course can help emergency planners and responders understand the requirements associated with providing temporary generator power to facilities.
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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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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
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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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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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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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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This resource provides tips on maintaining the integrity of vaccine supplies during a power outage.
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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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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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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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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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This fact sheet summarizes steps a healthcare facility can take to ensure communication during incident response when normal technologies fail.
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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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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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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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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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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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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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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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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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The author lists best practices for healthcare facility planners to consider regarding preventing, preparing for, and responding to water outages.
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The author lists best practices for healthcare facility planners to consider regarding preventing, preparing for, and responding to power outages.
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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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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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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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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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Tips for storing common medical devices and other products during and after a power outage are listed on this webpage.
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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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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
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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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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
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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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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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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This checklist can help emergency planners prepare for and respond to power outages in their facilities.
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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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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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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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This Excel spreadsheet can help medical facility planners prioritize and calculate a "risk rank" for electrical outlets during an outage.
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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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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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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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Agencies and Organizations
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