The Los Angeles County Emergency Medical Services (EMS) Agency has introduced groundbreaking new protocols to safeguard emergency power in hospitals following a Powered for Patients-led initiative that identified a number of vulnerabilities and recommended new measures to better protect patients during power outages.
The new protocols were introduced in the recently published Healthcare Facility Emergency Power Resilience Playbook, which is the culmination of the comprehensive emergency power resilience initiative launched by the EMS Agency in May 2019. The initiative was driven in part by the increasing use of Public Safety Power Shutoffs (PSPS) by Southern California Edison to reduce the risk of wildfires sparked by utility lines. Powered for Patients (P4P) was hired as the contractor to support the initiative. P4P founder and project director Eric Cote led the initiative and authored the recently published Playbook which has been distributed to all hospitals in LA County and sub-acute skilled nursing facilities.
During the initial phases of the initiative, Cote evaluated state and county emergency response plans to assess how they addressed threats to emergency power during a power outage. He also conducted a preliminary assessment of emergency power systems among a representative sample of LA County hospitals and created an inventory of temporary emergency power assets owned by LA County agencies and the cities of Long Beach and Los Angeles that could be deployed to hospitals during an emergency.
Cote concluded his initial work with a series of recommendations to address the vulnerabilities he uncovered, including the absence of any protocol addressing emergency power threat reporting and response. To address this gap, Cote recommended creation of an emergency power threat reporting protocol to provide county officials with an early warning at the first sign of a serious threat to emergency power during an outage. This improved situational awareness would accelerate government and private sector response to a stricken facility.
After touring emergency power systems at eight hospitals in LA County, Cote got his first glimpse of the vulnerabilities of some emergency power systems, leading to his recommendation that a census of every hospital’s emergency power system be conducted during a later phase of the project. Cote also proposed creation of a first-of-its-kind confidential risk rating of hospital emergency power systems to help county officials maintain higher vigilance of hospitals with risk factors such as outdated generators, limited onsite fuel storage or lack of redundant emergency power. Paying closer attention to the emergency power status of these higher risk facilities during an outage would give county officials a head start in addressing any threats to emergency power before they might trigger an emergency evacuation.
Cote’s census of emergency power systems in 80 LA county hospitals captured data on 271 generators and confirmed his concerns about an aging generator fleet. More than 30% of the generators captured in the census were over 30 years of age, considered the useful life of a generator based on a 2017 white paper published by Powered for Patients and the American Society of Healthcare Engineering. Among the county’s 14 single generator hospitals, the problem of outdated generators was twice as bad, with 64% of these facilities relying on generators in excess of 30 years of age, with some generators older than 40, 50 and even 60 years of age, a finding that raised serious concerns with EMS Agency leaders and public health officials in Sacramento.
“The discovery of so many outdated generators helped make the case for taking the unprecedented step of creating a confidential, risk rating of hospital emergency power systems,” said Cote. EMS Agency officials adopted a two-tier risk system, with higher risk facilities designated as Tier 2 facilities. EMS Agency officials staffing the agency’s 24/7, 365 Medical Alert Center, which will monitor emergency power status in LA County hospitals, will have restricted access to the list of Tier 2 hospitals so they know which ones to watch more closely during an outage.
The recently published Playbook introduces the risk tiers and a robust emergency power status reporting protocol that requires hospitals to report emergency power status through ReddiNet within 30 minutes of a power outage. ReddiNet is the online platform developed by the Hospital Association of Southern California (HASC) that is used by the LA County EMS Agency, and 21 other California counties, for two-way communications between county EMS officials and hospitals. ReddiNet enables EMS agencies to poll hospitals on their status and allows hospitals to post information about limitations they may face in accepting new patients or providing advanced life-saving services. ReddiNet developed a new emergency power status reporting dashboard to accommodate the new LA County EMS Agency protocol.
Over the past two months, training sessions and table-top exercises have been conducted for hospitals in Los Angeles County to introduce the Playbook and its new protocols.