NFPA Journal - January/February 2014 - (Page 51)

outages, and this can be an issue for all kinds of health care facilities." There were a number of possible reasons why Memorial's backup generators failed, Fink says. That failure was a point of contention in a civil suit brought by patients, relatives, and others against the hospital and its parent company, Tenet Healthcare Corporation, and the precise cause of the failure varied depending on who was asked. Among the possible contributing factors, Fink says, is that the generators weren't very robust to begin with, and that testing requirements did not push the generators enough to reveal the kinds of problems that could arise during a prolonged outage. NFPA codes and standards address these issues through a variety of provisions. NFPA 99, Health Care Facilities, for example, requires a Type 1 or Type 2 essential electrical system [EES] for most health care facilities, including hospitals and nursing homes, according to Jonathan Hart, a fire protection engineer at NFPA. The EES encompasses the entire electrical system, from the generator set to the transfer switches to the system's various branches. NFPA 99 requires these systems to be Class "X" emergency power supplies, where the number "X" defines the minimum time in hours for which an emergency power supply system is designed to operate at its rated load without being refueled or recharged. "There are specific numbers of hours that can be assigned, but NFPA 99 allows for facilities to make that decision themselves," says Hart. That decision should be made in conjunction with the facility's emergency management plan [EMP]. The EMP does not require the emergency power supply to be a Class 96, Hart says; instead, it instructs facilities to identify possible resource shortfalls after 96 hours, including fuel, and to plan for ways to mitigate those shortfalls if they are necessary and feasible. In some states, the EMP includes a list of resources such as available bed space at surrounding facilities, the sta- One Of the heartbreaking aspects of Five Days at Memorial is realizing that the hospital's fate was far from inevitable: what happened did not have to happen. Instead, an accretion of circumstances, events, and decisions gradually eliminated the hospital staff's options for what to do with its most vulnerable patients. tus of fuel deliveries, and the availability of contractors to perform emergency on-site repairs to generators, HVAC equipment, and other systems. Fink also finds reasons for cautious optimism. She sees more of a national engagement taking place with the concept of crisis standards of care, which addresses questions of how scarce resources can be allocated and managed in a disaster and how we can avoid those kinds of scarcities to begin with. She offers an example from Memorial: Who should be given priority for spots on a rescue helicopter? "There's no one way to decide who gets a life-saving resource," she says. "There are a lot of different ways to approach that question." Despite increased engagement with such issues, gaps persist. "Very few of the doctors I speak to know about the work going on in this area," Fink told Journal. "But in order for these protocols to work, there needs to be more awareness, and a more inclusive input in the creation of these protocols, as well as more research on them." Building a larger sense of awareness, especially around some of health care's core vulnerabilities, is also necessary if we want to prompt change, Fink says. "I think there can be a desire to diminish the public's perception that we are vulnerable, and that's really unfortunate," she says. "It's only when the public knows what these vulnerabilities are that it will support the kinds of critical investments necessary to fix them-it's why the places that tend to act, that do make those investments, are the ones that have gone through a disaster and know what the stakes are for failing to prepare. Organizations like NFPA can perform a great public service by engaging the public with these issues." One of the heartbreaking aspects of reading Five Days at Memorial is realizing that the hospital's fate, especially the fate of its intensive-care and longterm acute-care patients, was far from inevitable: what happened did not have to happen. Instead, an accretion of circumstances, events, and decisions-the moments Fink captures with such nuance and clarity-gradually eliminated the hospital staff's options for what to do with its most vulnerable patients. Codes and standards, Fink says, can offer a strong defense against the circumstances and forces that hobbled Memorial and made it a worst-case cautionary tale. "Ultimately, the mission of health care standards is to protect us when we are most in need," she says. "We should be proud of the standards we have, but we also need to recognize our vulnerabilities. We don't want to be a country where hospitals collapse in earthquakes. We need to acknowledge the gaps in our emergency preparedness and make the investments necessary to balance fiscal concerns with a commitment to assist the people who need help the most. We need to look at these problems and ask ourselves what we want to be as a country." Scott Sutherland is executive editor of NFPA Journal. JANUARY/FEBRUARY 2014 NFPA JOURNAL 51

Table of Contents for the Digital Edition of NFPA Journal - January/February 2014

NFPA Journal - January/February 2014
Contents
First Word
In a Flash
Perspectives
In Compliance
First Responder
Research
Wildfire Watch
Outreach
Firewatch
#Are You Prepared?
Life and Death at Memorial
Barrier Smarts
Perfect Storm
Conference & Expo Preview
Section Spotlight
Product Showcase
Looking Back

NFPA Journal - January/February 2014