Embed Size (px)
Citation preview
2017
Health System Resilience Following an Electromagnetic Pulse
Cleveland Convention Center
Austin, Texas
Richard M. Krieg, PhD
Oct 30 – Nov 3, 2017
President, Krieg Group
2017
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.
InfraGard EMP-SIG Report
2017Hospital 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.
2017Definition: 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
2017Katrina 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
2017Fragility 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
2017Healthcare 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
2017
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
Health Facility EMP Resilience
2017Health 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.
2017Two 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.
2017
▪ 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.
EMP Resilience: The Necessity of Hospital Water Supply
2017
National Infrastructure Advisory Council (NIAC) “Critical Infrastructure Dependence on Water and Potential Function Degradation following Loss of Water”Water Services
Massive Water Vulnerabilities
2017Ongoing Hospital Water Requirements
2017EMP-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.
2017EMP-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 needs3. Analysis of emergency water conservation measures4. Identification of alternative water supplies; and5. Development of an emergency water restriction plan
2017Alternative 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
2017Important 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.
2017The 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.
2017The US Electric Grid
2017
2017Impact 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.
2017
▪ 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.
Hospital Power Needs
2017
▪ 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.
Limited Hospital Power Backup
2017Health 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.
2017Health 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.
2017
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
Finally, Other Microgrid Advantages for Health Providers
