The power outage in California reveals the fragile health care system

There is a blackout, a planned blackout to reduce the fire risk for your community just west of Sacramento, and now you are faced with a decision: keep your fridge full of vaccines active or keep the electronic medical records of the community online? Your backup generator cannot do both.


This sounds like a hypothetical, but it isn't. Winters Healthcare, based in Winters, California, was confronted with this decision when its utility company, Pacific Gas and Electric Company, cut off part of its electricity grid to reduce the risk of new fires. And because the blackouts are likely to continue in the near future, it is a question that other healthcare institutions will face.

Winters Healthcare chose to use enough light to allow people to see and run the generator to keep the electronic health records accessible, Winters Healthcare director Christopher Kelsch said The edge. He decided to close the dental clinic and sent his vaccines to a sister clinic that was not expected to lose strength.

The clinic has emergency plans for accidental, weather-related failures that are quickly corrected, but the ambiguity of the length and timing of this blackout made things challenging. “They said we could be out of use for 24 to 48 hours, and it could be five days. It is hard to know what to do, "says Kelsch. They were not the only ones who were wondering. The closures left around 2 million people without municipal power and hit a number of hospitals and clinics in the region.

The health care system in the United States relies on electricity to function normally: it needs power to control everything from fans to electronic medical records, to ferry patients via hospital lifts, refrigerated medicines and countless other tasks. But the planned outage of PG&E was not the last. There were more outages last week, and they are likely to occur more frequently because the changing climate keeps California dry and makes fires more likely. The number of weather-related power outages is also increasing as extreme weather conditions occur more often. That is why it is more critical than ever that healthcare institutions are prepared for a present and future in which electricity is not a guarantee.

"We are so used to an uninterrupted power supply," says Grete Porteous, anesthesiologist and specialist in emergency medicine at the Virginia Mason Medical Center in Seattle. "It really surprises people to understand that this is all very vulnerable."

To receive federal funding for Medicare and Medicaid, hospitals providing critical care are required to have generators that can control their essential functions. The Joint Commission, which recognizes hospitals, calls on them to have emergency plans and to have generators tested regularly. However, despite precautions, generators can be vulnerable during disasters. For example, the Langone Medical Center at NYU included important components of the backup system in the cellar, which was flooded during Superstorm Sandy in 2012, turning off all power to the hospital. "Just because you have generators doesn't mean they work or work long enough," says Porteous.


Many generators also have a delay time before they start, and the few seconds that equipment fails can cause a long restart, which can put patients at risk if they depend on a machine running constantly, Porteous says. Current fluctuations can also cause damage to sensitive equipment. Deciding which parts of the hospital get power can be painful. The operations and the intensive care units are usually driven first. But that leaves other parts of the facility in the dark, which can be dangerous for patients – perhaps because medicines can be stored in electronically locked dosing units, maybe because refrigerators that store insulin don't stay cold when the power goes out, or, more everyday, perhaps because patients stumble more often in the dark.

Outpatient clinics, which are not subject to the same rules as hospitals, operate with even less safety net.

Many community clinics, such as Winters Healthcare, do not always have generators or redundant feeding systems. For example, John Muir Health, a network of hospitals and health clinics near San Francisco, California, had to run around during the power failure to move vaccines and drugs from facilities that would lose power, communicate with patients, and reschedule appointments.

If the power is off in a community, people who rely on electricity at home to maintain their health – such as people with breathing equipment – can turn to hospitals that may be overwhelmed by the influx. "A classic example is when a nursing home writes a hospital in their contingency plan and doesn't tell the hospital," says Kristi Koenig, EMS director of the San Diego district and professor emerita of emergency medicine and public health at the University of California, Irvine.

Some healthcare institutions look carefully at their feeding systems to make their services less vulnerable to sudden downtime.

A few years ago, Porteous and Chris Johnson, then the Emergency Management Program manager at Virginia Mason in Seattle, meticulously investigated all current-dependent elements of their hospital in preparation for planned electrical upgrades that could have endangered their generator. "We looked at each piece of medical equipment and asked if it had a battery, and how long did it last," says Johnson, who is now director of safety, security, and emergency management at Valley Medical Center in Washington State. They also looked at the elevators and realized that it would be almost impossible to move critically ill patients without them. "We had to have a plan to keep them in place."

"A lot of work has been done to ensure that we are prepared for power outages," says Johnson. Hospital leadership support was needed to do such a comprehensive evaluation, which is not guaranteed everywhere, he says.


"There are people who pay more attention, and are champions for preparedness," says Koenig. "But it's hard to get people to drill, and to plan for the" what if ", even though the" what if "is inevitable. Doctors are so busy, day by day – it's hard to get a trauma surgeon to play in a disaster exercise. "

Porteous, who leads the anesthesiology residency program in Virginia Mason, performs simulations with residents who ask them to think about the best way to provide care during a power outage. But most American doctors don't train for that scenario. "In other parts of the world, power can fail several times a day," she says. "That mentality is the opposite of medical care in the US."

Hospitals and health care systems in the US also have paper thin financial margins, and it can be a challenge to convince decision makers to invest in emergency preparedness, Johnson says. For example, the Bellevue Hospital in New York moved its back-up electrical systems to higher floors after Sandy. But those updates are expensive. Facilities may not have the means to relocate generators, or they may not think that redundant systems and backups are the best way to distribute financing. “Unfortunately, many hospital administrators feel that they have never had a problem before, so why change something? But then bad things happen. & # 39;

Having a regular power outage in the news makes people more aware of the problem, Johnson says. When this happens, this is an opportunity to show managers why they should invest in emergency preparedness measures. "We can say, oh, we saw something happen in a hospital in Missouri, what would we do in that situation?"

Preparing for power outages caused by a hurricane and outages caused by intentional shutdowns, such as those in California, need the same preparation level, says Koenig. "It doesn't really matter, because you have to focus on patients and the care needs of patients."


John Muir Health evaluates his response to the outage and determines what kind of changes he should make in the future, says Ben Drew, director of business communication. Winters Healthcare does the same: when the power returned, Kelsch went to the store to get more emergency lighting and an extra generator. "It is not that something is happening this weekend, but we want to be prepared for it to happen again. We know that the new can be normal.