While cybersecurity threatens all hospitals, Mother Nature targets hospitals by region.
Snowfall totals in Buffalo make provider access difficult even for a city used to plowing 93.4 inches each winter; hurricanes such as Katrina in New Orleans, flood coastal city hospitals; tornadoes rip out power for hospitals in Texas, Oklahoma, Kansas and other midwestern states east of the Rockies; and west of the Rockies, especially for California and Washington State, earthquakes make patient evacuations a decision to be made immediately.
The morning of July 4, the Ridgecrest earthquake shook southern California at a magnitude of 6.4, fracturing roads and, as shown in a video that went viral, sending water splashing over the rim of an inground swimming pool. It was followed a day-and-a-half later by a magnitude 7.1 quake.
Ridgecrest Regional spent $72 million on a building designed to withstand an earthquake, and the structure did. But broken water pipes forced an evacuation anyway.
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Ridgecrest Regional is joining other hospitals in the state questioning earthquake standards set to take effect in 2030, that are meant to keep the doors open, but are also tremendously expensive.
Evacuation after an earthquake is a decision that must be quickly made, during a time when the natural disaster is disrupting power, communication and care. Administrators, physicians, nurses and other staff are concentrating on patient safety while likely being concerned about what's happening with their own families.
"An earthquake presents unique preparedness challenges for hospitals," said Jason Burnham, associate director of Outbreak Readiness, O&M Halyard. "In disasters like an earthquake, three areas to plan for include patient and staff safety, potential impact to the facility operations, and supply line continuity."
Planning can help pressure test the functionality of each workstream in a mobile or alternate site scenario, Burnham said.
Sensors have long been used to determine whether a building is structurally sound after an earthquake.
"That doesn't help the people who have to make decisions while the earthquake event is happening," said Brandon Parrott, who leads product development and marketing at Kinemetrics in Pasadena, California.
They're asking, he said, "'Is my building safe. What do we do next?' That is the gap we're trying to close right now. We've been focusing on the hospitals."
A new product sends out a report in real time to hospital staff who have the app. Kinemetrics developed OasisPlus after a 6.8 magnitude earthquake hit Washington State in 2011, damaging the Naval Hospital Bremerton.
"Things fell over," Parrott said. Staff was asking, he said, "'Is it safe to be in here?' They did inspections, said the building was fine and now we need to focus on the non-structural impact. Then the fire marshal said, 'This looks really bad, we need to evacuate.' They set up temporary facilities in the parking lot. Then the engineers showed up and did an evaluation and said, 'This building is fine.'"
During the inspections, officials came across a Kinemetrics black box seismic monitor from the 1970s. The company decided to build new technology over the old instrumentation.
"As soon as building moves, sensors tell us how it moved in the different locations within the building," Parrott said. "OasisPlus calculates a heat map that shows the expected impact in the different areas, including occupant discomfort, non-structural damage, and structural damage. This information is immediately sent out via text or email in what we call a SAFE report. As building occupants report in using the mobile app, responders receive information about specific damage, such as leaks in water pipes, or blocked exit routes. That combined information goes back to a command counsel, where it's presented as a set of heat maps on the building's floor plan."
Everyone with a mobile app gets an automated report.
The foundation for the sensors has been around for a long time. The response piece is new. Hospitals are just starting to implement it, Parrott said.
Hospitals should have a team that can assess the viability of critical systems in the facility, and have on the team a representative from IT, given the heavy reliance on software and data, Burnham said.
"First and foremost, every hospital should be prepared to deploy teams simultaneously and immediately. Having a playbook in advance and separate teams identified for each area - staff and patient safety, facility operations, and critical supplies and equipment – is essential to initiating an effective response," he said.
Someone should be monitoring the immediate supplies on hand as well to ensure an uninterrupted flow of supplies, should there be a shortage. A strategic supplier and distributor need to be on the immediate response team.
Hospitals need to know the secondary processes if power, utilities, and mechanical systems are compromised. Outages of critical software and data systems, such as electronic records or internal/external transaction systems, need a back-up plan.
"In emergency planning, a common gap we see is limiting planning to just one or two scenarios," Burnham said. "Facilities are often focused on just the last type of emergency experienced, whether an earthquake, fire, hurricane, flood, tornado, or an outbreak. Often equal planning is not given to a second or third scenario."
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