Health System Resilience Following an Electromagnetic Pulse

Transcription

1 Health System Resilience Following an Electromagnetic Pulse Cleveland Convention Center Oct 30 Nov 3, Richard M. Krieg, PhD President, Krieg Group Austin, Texas

2 InfraGard EMP-SIG Report In the event that a widespread failure of electrical power, takes down critical infrastructures for a long duration, sufficient relief, whether from government and/or other sources, probably will not be available. Depending on the duration of the infrastructure failure, consequences for unprepared citizens could go well beyond economic loss to include sickness and death from dehydration, disease, pollution, exposure, starvation, fire and civil unrest. Consequences for the nation could include a breakdown of coherent central government (local, state and federal) leading to possible loss, at least temporarily, of effective sovereignty: the full right and power of governing bodies to govern itself without outside interference. There could also be unacceptable delays in recovery, resulting in extensive loss of life and property.

3 Hospital and Health Care Delivery Systems These systems critical to community survival during and following disasters, including: Natural disasters including floods, earthquakes, fires Manmade events such as multi-vehicular crashes, mass shootings, chemical spills, explosions Large-scale terrorist attacks on the homeland Electromagnetic pulse (EMP), caused by a coronal mass ejection, a physical attack on the electric grid, cyber attack or an atmospheric nuclear detonation.

4 Definition: Health System EMP Resilience The ability of hospitals and other providers to resist, absorb, and respond to an extended power outage while maintaining and surging essential health services, and then to recover to their original state or adapt to a new one

5 Katrina Hospital Experience (Urban Institute Study) Power loss prevented vital equipment use e.g. as lab and x-ray, dialysis machines, and elevators Temperatures rose above 100 degrees in many hospitals Water supply quickly depleted due to local energy outages Personnel brushed teeth with and drank IV fluid Toilet and sewage back ups. Staff slept on roof due to stench Struggle to care for ventilator-dependent patients - nursing teams alternate 30-minute shifts to hand-operate then family members trained to take over. Emergency surgery done by flashlight Critically ill patients carried up and down dark stairwells because the elevators were not working

6 Fragility of Healthcare in Disaster Conditions Hospitals esp. academic health centers are large, complex, multi-faceted organizations Multiple lines of authority - hospital admin, departmental, medical and nursing staffs, university, etc. Physicians are gatekeepers. Less than efficient patient triage Information systems often fragmented and do not lend themselves to rapid management decision-making Coordination often inadequate between public health agencies (emergency mobilization, disease surveillance) and health care providers While usually represented in government emergency operation centers, may lack interoperability of communications across health system components. Just in time inventory of pharma, food, medical supplies, etc

7 Healthcare System Anomalies At metropolitan level, the health care delivery system is highly fragmented, e.g. hospital ownership Strong competition between health facilities information sharing uncommon Multiple tiers of care low income patients, public hospitals, private hospitals, etc. The hospital service mix is reflection of patient funding Emphasis inpatient as opposed to community-based care

8 Health Facility EMP Resilience Robustness: strength or the ability of health facilities or health systems to withstand an EMP given the length of the power outage, and the extent to which healthcare functions can be maintained Redundancy: the extent to which the components of health facilities can be substituted to maintain health functions and surge capacity in the event of an EMP

9 Health Facility EMP Resilience Resourcefulness: the ability to identify problems, establish priorities, and mobilize resources when the EMP occurs; resourcefulness includes flexible plans, strategies and procedures to apply or coordinate resources (e.g., human resources, medications, and equipment) to meet healthcare priorities as the EMP unfolds Rapidity: Following an EMP, the speed with which health facilities achieve an acceptable level of operational functions through responsiveness, recovery and adaptation.

10 Two Major Vulnerabilities Two areas of extraordinary importance during prolonged disasters Loss of power and related depletion of potable and non-potable water supply. In both instances, impacts severe - cascading to nearly every department in the system.

11 EMP Resilience: The Necessity of Hospital Water Supply There is typically a single day s supply in municipal systems relying on gravity pressure. The lack of water would hit health care providers quicker and harder than any other sector. May be the single greatest obstacle facing health care providers in extended power outages.

12 Massive Water Vulnerabilities National Infrastructure Advisory Council (NIAC) Critical Infrastructure Dependence on Water and Potential Function Degradation following Loss of Water Water Services

13 Ongoing Hospital Water Requirements

14 EMP-related Water Supply Planning Robust plan necessary to meet EMP-level water requirements Full engagement should be sought from local public water department, state drinking water agency, local and/or county public health department, local fire department and water reclamation/purification department. Essential to conduct adequate water audit to identify emergency conservation efforts under EMP conditions.

15 EMP-related Water Supply Planning Audit should include the following elements: 1. A read out of water usage under normal operating conditions broken out by function 2. Identification of essential functions and minimal water needs 3. Analysis of emergency water conservation measures 4. Identification of alternative water supplies; and 5. Development of an emergency water restriction plan

16 Alternative Water Sources Potable water storage tanks on or near the hospital campus Arrangements with another public water supplier to obtain potable water. Investigation of tanker transported water Wells can provide dependable source of water for most health care facilities, but essential to have an adequate emergency power supply Nearby surface water such a a lake, pond, creek, or storm water retention pond with appropriate treatment can provide an alternative potable or non-potable supply

17 Important Factors Significant amount of planning beforehand to ensure that agreements, equipment and procedures are in place. The water plan should be a key component of the overall facility emergency management plan - and should be exercised on a regular basis. Exercises can range from a relatively simple tabletop exercise with hospital staff to a larger functional exercise involving appropriate outside agencies.

18 The US Electric Grid 8 regional components and more than 1,400 independent and semi-independent power companies 200,000 miles of high voltage transmission lines and 5.5 million miles of local distribution lines Engineered to balance demand and supply at every second; therefor, generator operation extremely important, Electricity derived from multiple sources, e.g. gas and coal based utilities, nuclear, hydroelectric, solar, wind, etc.

19 The US Electric Grid

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21 Impact of Extended Power Outages on Healthcare Limited assessment to date esp. implications of simultaneous loss of both power and communication grids. Hurricanes Katrina and Sandy and the 2003 Northeast Blackout, demonstrated enormous impacts. Major problems in access to healthcare, hospital operation, maintaining frontline services and providing care in community clinic settings. Many hospitals became dark and dangerous places.

22 Hospital Power Needs Most hospitals have migrated to an almost completely paperless, electronic operation. Beyond communications, medical technology is highly sophisticated and interconnected. Includes electronic controls of imaging equipment such as MRI and CT Scans, electronic health records, operating theater management systems, laboratory information programs and many other power-dependent resources. A variety of life-saving patient monitors and pumps have complex control systems requiring uninterrupted power supply.

23 Limited Hospital Power Backup Estimated that life critical in-hospital care, e.g. emergency rooms, life support systems, and operating rooms, generally have full power backup for 3 days. For less critical services e.g. refrigeration, sanitation and cooling, the availability of backup is more limited.

24 Health Care EMP Planning Should Emphasize Microgrids Hospitals are dependent on having a continuous, uninterrupted supply of power. The majority of healthcare facilities maintain on-site generators (mostly diesel) for emergencies because modest power loss can have highly negative consequences. Need systems with automated controls to balance system demand with energy supply from backup generation, the public grid and local storage assets.

25 Health Care EMP Planning Should Emphasize Microgrids EMP-SIG s Powering Through emphasizes the concept of community islanding as a key survival strategy for EMP preparedness. Maximum consideration should be given to microgrids discrete energy systems consisting of distributed energy sources (renewables, conventional, storage) and loads capable of operating in parallel with, or independently from, the main grid. Health system microgrids should be EMP protected and include power generation, a distribution system, consumption and storage. Managed with advanced monitoring, control and automated systems. Importantly, the fully developed microgrid has the capability of automatically disconnecting and operating independently from the main grid.

26 Finally, Other Microgrid Advantages for Health Providers Hospital systems considering microgrid investment should consider the following value proposition: Efficiency lower energy intensity and distribution loss Reliability near 100% uptime for critical loads Security enhance cyber security and physical security Quality stable power to meet the hospital s precise requirements Sustainability expand generation to renewables and cleaner fuel sources

27 Richard M. Krieg, PhD