In May 2019, the Los Angeles County Emergency Medical Services Agency executed a contract with Powered for Patients to lead a multi-phase emergency power resilience initiative focused on safeguarding emergency power in critical healthcare facilities. P4P project director Eric Cote led the initiative which culminated in October 2023 with the publication of the Healthcare Facility Emergency Power Resilience Playbook. The Playbook introduces new protocols Cote recommended to better safeguard emergency power in LA County hospitals.
Cote’s recommendations were intended to address vulnerabilities he identified during his initial work, which included a review of state and county emergency response plans, and a preliminary assessment of emergency power systems among a representative sample of LA County hospitals. Cote also 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.
Among the vulnerabilities Cote detailed in his Phase I report was 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hospitals in LA County, Cote got his first glimpse of the vulnerabilities of some emergency power systems, including outdated generators, leading to his recommendation that a census of every hospital’s emergency power system be conducted during a later phase of the project.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emergency power systems to help county officials maintain closer vigilance of hospitals with risk factors such as outdated generators, limited onsite fuel storage or lack of redundant emergency power.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 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.
To provide enhanced situational awareness of generator status in single generator facilities, the LA County EMS Agency offered funding in 2021 to the 14 single generator hospitals included in the census to deploy Power P.I.O.N.E.E.R., a real-time emergency power monitoring system developed by P4P with funding from the Department of Homeland Security.
P.I.O.N.E.E.R., which stands for Power Information Needed to Expedite Emergency Response, provides real time, automated alerts when emergency power is threatened during power outages, enabling accelerated EMS Agency and utility response to support a stricken facility.
Cote and his LA County EMS Agency clients, Disaster Services Chief Terry Crammer and Disaster Program Manager Chris Sandoval, introduced the Playbook and its new protocols at a panel discussion on October 5, 2023 during the California Hospital Association’s Emergency Preparedness conference. “The Playbook is a blueprint that can serve as a roadmap other jurisdictions can follow to bolster emergency power resilience in their hospitals,” said Cote, who is currently developing a toolkit other jurisdictions can use to guide their own efforts to adapt the LA County Playbook to their jurisdiction’s hospital landscape.