By K. Richard Douglas
In November 2018, the deadliest fire in California history ignited. For more than two weeks, it would cause catastrophic damage to the town of Paradise. The Camp Fire resulted in 85 people losing their lives, more than 153,000 acres were burned and 14,000 homes were lost.
When the fire was approaching Adventist Health Feather River Hospital in Paradise, the staff realized that they would have to quickly evacuate 67 patients. Clinical and support staff all went into action including the hospital’s four-man biomed department.
The biomeds found as many wheelchairs as they could and staged them in front of every patient room in the med and cardiac/neuro units. They pushed patients in their beds to the ambulance bay for evacuation. Patients also had to be quickly loaded into ambulances and personal vehicles for evacuation.
One of the hospital’s biomeds at the time of the fire was Marc Silver, BMET III.
“Pay attention to, and know what to do, in a disaster. Be prepared and be ready. Know your role and learn the job of others as well so you can assist. Know where things are stored or how to properly mark a room cleared in a fire/drill,” Silver says.
“Keep a calm head, and be flexible. Adapt and overcome,” he adds.
While most hospitals are more likely to experience a number of other emergencies before the risk of a wildfire, the experience of the biomeds at Feather River is instructive; an emergency could arrive at the doorstep and biomeds have to be prepared. Biomeds may have to take on a role that goes beyond medical equipment.
“In hindsight, the only thing I can think of is biomed departments should have a clear plan for evacuation. There were only a few minutes for any discussion. We evacuated 10 years prior, having a whole day to do it. We were able to check all equipment leaving with patients and where they were going. This one was all about escaping with our lives,” says Rob Harry, the biomedical engineering site director at Feather River at the time of the fire.
In 2016, CMS published the Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule. Health care providers were expected to have the rule implemented by November 15, 2017.
The purpose of the regulation was to “establish national emergency preparedness requirements to ensure adequate planning for both natural and man-made disasters, and coordination with federal, state, tribal, regional and local emergency preparedness systems,” according the CMS’s website.
The agency further stated that compliance with the regulations was necessary for participation in the Medicare or Medicaid programs. It was also a requirement that each provider and supplier have their own set of emergency preparedness regulations.
The need for these established procedures has become evident for the many health care facilities that have experienced natural and man-made disasters such as hurricanes, tornados, flooding, wild fires, the treatment of victims of mass shootings and earthquakes.
Having an emergency plan provides a framework for emergency preparedness.
These rules are in place to deal with homeland security, power outages and disease outbreaks as well. The rules protect patients, clients, residents and participants during disasters or emergency situations.
According to the 2019 revised rule, “The requirements are focused on three key essentials necessary for maintaining access to health care during disasters or emergencies: safeguarding human resources, maintaining business continuity and protecting physical resources.”
HTM Professionals Provide Special Skill Set
Biomeds have learned from experience that emergency situations have called upon both their skill sets to prepare and protect medical devices, and often to assist facilities in helping to evacuate or move patients. Those HTM professionals who have been on duty during an emergency have learned that it is often an “all hands on deck” situation and clear thinking and situational awareness are crucial.
In the case of the Camp Fire, biomeds sprang into action to help evacuate patients. In the case of Hurricane Maria, which hit Puerto Rico in 2017, the devastation was so vast that many hospitals were caught unprepared and half of the back-up generators failed.
“Hurricane Maria was not the only hurricane to hit Puerto Rico that year; Irma had some impact as well. The island infrastructure is old, so power becomes one of the biggest issues. Biomedical engineers are used to working under pressure to begin with, since power is not reliable,” says Enrique Vazquez, field sales service liaison with Avante Health Solutions.
Vazquez visited the island to repair equipment after the hurricane.
“While Hurricane Maria was close to the island, the biomedical teams were making sure that all the battery-operated equipment was working in good condition because of the category of this hurricane. The people knew this was going to have a big impact on the power grid and utilities,” he says.
Vazquez says that the surgical rooms needed to be preserved because even with power generators, power would need to be steady and maintained. The parts of the hospital that didn’t need power were turned off to minimize the load on the generators.
“Biomedical engineers, that had the task to work during the hurricane and after, [were] under great stress not knowing how their family were, among other worries. After the hurricane passed, it was total chaos for everyone that worked in a biomedical service roll. They were the front line to evaluate all of the damage, even the big iron like MRI,” Vazquez says.
He says that because of the hurricane, the cooling and the air conditioning failed for the MRI. “Power surges, due to generators failing, caused other equipment like CT scanners to fail,” Vazquez says.
He says that despite the mass destruction, there was one hospital available that was built to survive off the grid; built in between a mountainous area off of a small highway in the west coast of Puerto Rico.
“This hospital never closed its doors, it didn’t sustain any power damage, had minor structural building damage but never closed; it worked off its own power generators battery backup, water tanks that had unlimited supply because they tapped in to a well. It was a well-oiled machine,” Vazquez says.
Vazquez says other hospitals had to close because the damage was high, especially with power and utilities, oxygen was low and they could not generate it.
He says to prepare for a major disaster like Hurricane Maria, it is imperative that biomeds maintain critical medical equipment, find ways to work the hospital infrastructure off the grid, have a reliable safety plan with backup plans.
Vazquez also suggests that biomeds and other hospital staff run practice scenarios.
“How can we ensure that the hospitals have enough support staff. Biomedical engineers are working with so many pieces of equipment and short staffed until the hospital has a major event. Keep the communication lines open from phones and cell service. Radio emergency communication is very important. I understand that biomedical departments have emergency plans, but are they really involved in the planning?” he asks.
Vazquez went to the island right after Hurricane Maria and has been there several times since to help repair equipment.
“Even today some of the equipment is down due to the extent of damages,” Vazquez says.
The list of natural and man-made emergencies that have impacted hospitals during the past decade is extensive.
Hospitals Challenged by Terrorism
The year 2013 was a year that tested biomeds and other hospital staff at Boston Medical Center, when a terrorist attack during the running of the Boston Marathon took a devastating toll on spectators and racers. Terrorists had detonated two homemade pressure cooker bombs near the finish line.
More than 260 people were injured in the bombing, 16 lost limbs and three died. The worst injuries were traumatic amputations.
Victims were taken to 10 different hospitals in the Boston area. Twenty-three of the victims were transported to the Boston Medical Center, which is a level I trauma center and the city’s busiest.
In TechNation’s January 2015 cover story about disaster preparation, we quoted Jim Piepenbrink, who was the director of clinical engineering at the Boston Medical Center at the time of the bombings.
Piepenbrink said that he strongly encouraged others to take part in their organization’s emergency preparedness team.
“HTM professionals have critical thinking capabilities that are essential when dealing with disasters and quite often we have a very good understanding of how the organization is laid out and how different departments operate,” he said.
“We have a renewed focus on increasing the number of people who will participate in disaster management, especially at the command team level,” Piepenbrink said. “Disasters can last for days and we have worked at ensuring that we have a better bullpen of people we can draw from to ensure that people limit their shift so that they are making effective decisions and not getting burned out.”
“Additionally, we have beefed up our software solution to better capture necessary information so that we have a single lens into the activities during a disaster instead of manual and electronic monitoring of the situation,” he added.
Sonoma County, California was hit by wildfires in 2017. Jorge Contreras, CBET, TechNation’s professional of the month for May of 2018, experienced first-hand the requirements of dealing with an emergency. Contreras worked for enBio Corp and was assigned to Sonoma West Medical Center 2017.
He is currently the director of procurement at Sonoma Specialty Hospital in Sebastopol and oversees the biomedical engineering program there.
In his 2018 profile, Contreras recounted: “The fires started hours before the sun came up. By the time I woke up, we were in full-on disaster mode. I made it as early as I could and there were many unexpected challenges. Two of the other hospitals had closed and the hospital I support, Sonoma West Medical Center, was the only hospital open in the western part of the county,” he said.
“We received a large number of patients and suddenly there wasn’t enough staff because many had to escape the fires themselves with their families. I helped other departments whenever I could. I picked up empty food trays, helped environmental services out, whatever was needed – it was all hands on deck,” Contreras said.
“A strong challenge that came during the fires was the short supply of biomedical equipment at the hospital. It’s a 37-bed facility, but suddenly, we had patients out in the hallways and we needed equipment direly. Other hospitals in the area helped us out by loaning us their equipment and as the sole biomed, I was responsible for testing each device before placing it in service,” Contreras remembered.
“Other challenges were a lack of patient beds. I sought out vendors who could rent us the equipment but because of the fires there weren’t many responses. But; we pulled through, and the county, the staff and the residents of the town all became closer because of these events,” Contreras added.
Looking back with some more time to reflect on that experience, Contreras has some advice for other HTM professionals.
“First, one needs to be available to help. It begins with the willingness to put one’s self aside and make the patients the priority. I remember not eating at all during the first fire because I was needed on-site,” he says.
“Another thing, track all equipment that comes in. With the incoming patients we needed extra equipment and keeping track was vital. It’s easy to mix up your equipment with loaners so it’s important not to lose track of what comes in,” Contreras suggests.
He says that rental companies are necessary. During the floods last year, he says they struggled with finding spare equipment. The company he used quickly ran out and it’s necessary to have backups to your backups.
“Work with engineering. Know what challenges they face. If the facility starts running low on oxygen, then us biomeds need to find alternatives such as oxygen concentrators or compressors for ventilators,” Contreras says.
“Always keep an emergency supply of batteries. Telemetry, SPO2, etcetera, require batteries and during an emergency, deliveries will be slow to arrive. Remember, there’s your standard supply and then there’s the emergency supplies. These are two different things and one should never take from the emergency bin without replenishing,” he adds.
Contreras says that during any disaster it is all hands on deck. Come to work and be prepared to offer help in any way possible. Help with distributing supplies to the nurses.
“Environmental services crew may not be able to come to work and you may be needed to help clean up a room. The staff won’t have time to take a break and I remember the DON was making ham and cheese sandwiches for everyone. This is our duty during a disaster. We aren’t biomeds. We are members of the community and we’re called upon to help our neighbors,” he says.
Contreras says that a last thought on the topic is that you will be needed on-site. It’s our responsibility to be there and help sustain the hospital.
“You may feel the need to flee but you’ll be safe at your facility. There’s generators, food and safety in numbers. Bring your family if you have to. However, you will be needed to serve the hospital during an event. If not us, then who?” he asks.
Preparation is key in any disaster or emergency and knowing the experience of other HTM professionals can provide some useful guidance to know what planning is needed before or after the event. Knowing ahead of time can make life much easier and prevent further tragedy.
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